Are you in pain? Are your fingers and legs not as nimble as they used to be?
The most likely cause of your pain is compression of the spinal nerves by a combination of a prolapsed disc and overgrown bony spurs within the spinal canal, which together cause compression of the exiting nerve roots. Compression of the spinal cord itself is caused by a combination of prolapsed disc and overgrown bony spurs and ligaments. Spinal cord compression causes loss of dexterity of your fingers, arms, legs, and can even cause urinary difficulties. Excessive abnormal movement of bones over each other can be a cause of significant neck pain.
You will drift off to sleep under general anaesthesia in a safe and controlled fashion by an anaesthetist. Whilst you are under anaesthesia you will not feel any pain, nor will you be aware of time passing. Your head be kept steady in a vice to avoid any movements of your neck or spinal cord whilst the procedure is underway.
The operation will be on the posterior (back) aspect of your neck. Having cleaned your neck in a sterile fashion, an incision will be made in the skin, and the muscles overlying the bones and joints will be pushed off. Screws and rods will be placed into the bones, and then the laminae (part of the spinal bones in the neck) will be removed. This will allow us to decompress the spinal cord and the exiting nerve roots. Once a thorough decompression has been achieved, the wound will then be stitched up, and the anaesthetist will allow you to wake up in a safe manner.
The procedure itself will take approximately three hours, but your stay in the operating room environs may be a little longer than this.
The primary benefit of posterior cervical laminectomy and fusion is to provide a significantly more rapid relief of radicular arm pain, in patients who have failed more conservative treatment options. It also provides a relief of pressure off the spinal cord in patients who are myelopathic (difficulty walking/difficulty with fine motor tasks/clumsy weak arms & legs).
The main risks particularly associated this procedure are wound infection, failure of your symptoms to improve, worsening of your symptoms despite the pressure being taken off of your spinal cord, a recurrence of your symptoms, damage to the spinal nerves with resultant weakness of your legs or arms, paralysis due to spinal cord damage, or damage to your bladder and bowel continence.
Smoking in the 12 months prior to surgery, or in the 3 months after your surgery, increases your chances of experiencing a failed fusion, which may cause persistent neck pain requiring further surgery. The vertebral artery supplying the brain may be compromised by screw placement, resulting in stroke and/or death. A more extensive list of risks is detailed on the consent form.
In myelopathic cases, the function of this surgery is to hopefully prevent you deteriorating any further. Some patients find that their fine motor skills are improved after this surgery; a greater proportion of people however find that they're no better (though no worse either!), whilst a third category unfortunately deteriorate further despite MRIs showing the cord has been decompressed and the surgery being carried out in a safe fashion. I cannot say into which category you will fit, but if there is evidence of pressure on your spinal cord on the MRI, I do recommend you undergo this procedure.
Alternatives to anterior cervical discectomy and fusion would include physiotherapy, nerve root injections & epidural injections by a pain management specialist. These are successful in alleviating the pain temporarily, but will not remove the bony spurs or ligamentous overgrowth.
Pressure on the spinal cord causes permanent irreparable damage, and as such if you choose to not undergo surgery in the setting of cord compression, you are liable to experience progressive weakness of your arms and legs at a date in the future. You are also at increased risk of spinal cord damage in the event of being in a car accident or falling.
You will be admitted to hospital on the morning of surgery, and will be discharged home within 3 days. You will need to get somebody to drive you home from the hospital on the day of discharge. You will experience soreness in the back of your neck, and may experience shoulder and biceps pain - these discomforts will last between 2 and 3 weeks on average.
The stitches used to close the wound are dissolvable - you will not need to get them removed. You will receive a telephone call during the first week from our secretary to confirm that all is proceeding as we expected. You will have a stiff sore neck for the first 3 weeks after this procedure, but by the time you are reviewed in the clinic this should be significantly better. Typically an improvement in your arm or hand pain will be the first benefit you will notice after this procedure, next an improvement in any "pins-and-needles", and lastly an improvement in any numbness (this may take a number of months or may in fact persist permanently).
You will require a long course of physiotherapy - this rehabilitation is just as important as the surgery, and without it the surgery is largely useless. The scar will fade to a dull white mark over the next 12 months. You should not use any anti-inflammatories for the first 3months after this procedure - use of such products will delay the fusion process, and could cause a persistence of movement at the operated level. Such unwanted movement can be a source of a lot of pain, and may indeed require a further surgery.
Desk-work people are advised to refrain from returning to full-employment for 6 weeks. Housewives (and house-husbands!) need a similar period of time to recover also. People with flexible work hours, and those that can complete their duties whilst standing upright may return to work after 3 weeks. People who return to work too early have been shown to experience a greater degree of long-term neck pain. Physiotherapy exercises should commence after 6 weeks. Hard or foam collars should not be worn.
Athletes can usually return to gymnasium and track training in approximately 10 weeks, though each case will need to be judged on it's individual merits, taking factors such as the athlete's age, particular athletic activity, and body habitus into account. Should your MRI reveal evidence of spinal cord damage already, it is advised that you not participate again in contact sports.
You will be reviewed in the clinic after 6 weeks, and again 3 months later to confirm that your recovery has proceeded satisfactorily, and will further imaging tests or therapies as required. You will have been given a regime of neck muscle exercises by the physiotherapy department - it is important that these exercises become as regular a part of your daily routine as brushing your teeth!
Should you experience any unusual symptoms or signs either prior to your surgery or during your subsequent recovery period you must contact our office line immediately. Should that not be possible, we would advise you to seek immediate medical advice from a registered medical practitioner. Urinary or faecal incontinence, urinary retention, constipation, difficulty breathing or completing sentences, new-onset numbness or leg weakness, a painful calf or thigh (especially if red or swollen) are all reasons to call us immediately, or to go to your local hospital emergency department.
Always tell your surgeon if you are taking Aspirin, Disprin, Plavix (Clopidrogel), Warfarin, Dipyridamole (Persantine), Asasantin, Aggrenox or if your medical condition has changed in any respect in the period of time prior to your procedure.
If you haven’t any health insurance cover, then spinal surgery in a private hospital can be expensive. My secretary can call the hospitals and get an all-in price for any procedures that I may recommend.
Whilst spinal surgery is expensive, the cost of not being able to work to full capacity is often more financially debilitating.
Yes. I would be very happy to see you and treat you in the public health system also in Tallaght University Hospital or Naas General Hospital. An unfortunate result of decades of inadequate resourcing of both the hospital network in general, and spinal surgery specifically, is an admittedly unacceptable long waiting time both to be seen in the outpatients clinic and to be operated on. All patients are seen and operated on on the basis of clinical need.