Surgery to the back of the neck
From BCSS
Contents |
Information leaflet for patients
An operation of the type described in this leaflet is a standard procedure carried out by orthopaedic surgeons and neurosurgeons in many centres. However, it is important that you understand the risks and benefits of such surgery. This leaflet is intended to provide you only with general information. Your surgeon will discuss with you the particulars of your individual case.
Reasons for surgery to the back of the neck
There are many different reasons for carrying out an operation to the back of the neck but this leaflet only deals with those conditions that result from “wear and tear” of the bones, discs and joints in the neck, and the effects that those conditions can have on the spinal cord and the individual nerves. Wear and tear or degenerative change in the neck is called a number of things by different people, one common term being “spondylosis”
The operation may be carried out to relieve pain coming from the neck into the arm from a localised problem in the neck, or to relieve pressure on the spinal cord or nerves, or a combination of the two.
The Operation
The operation is carried out through a cut at the back of the neck. The operation involves decompressing or freeing the individual nerves and/or the spinal cord and this may be done in a variety of ways. It may involve removing bone that is trapping an individual nerve (foraminotomy), removing the bone and soft tissues (ligaments) that are trapping the spinal cord (laminectomy) or a combination of the two. Sometimes the decompression will involve making more room for the spinal cord by partially detaching the lamina rather than removing it (laminoplasty). In addition, in some cases it may be necessary to fuse or lock the bones together using bone graft (e.g. from the back of your hip) and/or a metallic internal fixation device. There are a variety of methods and devices that your surgeon will explain to you.
Benefits of Surgery
Where there is pressure on a nerve with severe symptoms in the arm, the majority of patients will have dramatic relief particularly if their arm symptoms stop. However, sometimes the pressure on the nerve has resulted in some permanent damage. In such cases, the relief of symptoms and return of function may be incomplete and disappointing.
If there is pressure on the spinal cord giving rise to problems in the legs, then the main reason for carrying out the surgery is to prevent matters getting worse. Improvement is unpredictable and recovery is often incomplete. It is a bonus if there is significant improvement in the function of the spinal cord.
As far as pain in the neck is concerned, the surgery might lead to improvements in the pain, but as is often the case with wear and tear degenerative problems, it is likely that you will still have some neck pain and stiffness.
Risks of Surgery
The scar at the back of your neck, or any scar related to removal of bone from your hip, is not normally a problem. However, some patients have pain at the site where bone graft has been taken.
Any surgical wound can become infected but the risk of infection in wounds for this type of surgery is very low indeed. When infection occurs, this is not usually a serious matter and the risk of long-term problems from this is very low. If metal has been attached to the spine at surgery, infection can sometimes result in serious complications.
The spinal cord and nerve roots are bathed in a fluid (cerebrospinal fluid) and the surgery can result in some leak of this fluid. Of itself, this is not a serious matter and the risk of long-term problems is very low. However, there is a very small risk of complications from such a leak, including meningitis. Sometimes, a further smaller operation is needed to seal the leak.
What understandably worries patients most about an operation on the neck is the risk of permanent paralysis. Surgery of this sort involves working close to both individual nerves and the spinal cord and the risk of paralysis can never completely be ruled out. If an individual nerve is damaged, this may result in permanent increased pain, numbness and/or partial weakness in one of your arms. Should the spinal cord be damaged, there is in addition the risk or permanent paralysis in the legs together with loss of control of the bladder and bowels (incontinence of urine and faeces). Fortunately the risk of catastrophic complications such as this is extremely low. Your surgeon will warn you if the risk in your case is increased for any reason.
If you have any doubts or questions on reading this leaflet, you should discuss them with your surgeon.
Disclaimer: This information has been provided by the British Cervical Spine Society for the information of patients. The Society accepts no responsibility for the effects of any surgery that may be decided on by an individual surgeon and his patient.
BCSS August 2006
