Cervical laminectomy for spinal cord compression Information for patients Neurosurgery
What is a compression of the spinal cord and how has it been caused? The bones in our back are called vertebras and each one is separated by an inter-vertebral disc. Behind the vertebral bones/disc joints is the spinal canal containing the spinal cord. Each disc joint acts like a pressure cushion and allows movement between each vertebral bone. Disc joints can be affected by wear and tear/degenerative changes, (a process also known as spondylosis), this results in bulging of the disc and overgrowth of adjacent bone edges (osteophyte formation). In a small proportion of affected individuals, the extent of such wear and tear/degenerative changes causes narrowing of the spinal canal (canal stenosis) with compression of the spinal cord (myelopathy). What are the symptoms? Continued compression of the spinal cord leads to difficulty walking, ultimately to the point of being wheelchair bound. If the level of the cord compression is in the upper part of the cervical spine, the hands and fingers also become affected with gradual loss of fine finger movements, e.g. difficulty using knife and fork, doing buttons up, or handling coins. How is the diagnosis made? The diagnosis of a disc bulge/osteophyte causing cord compression is confirmed by doing an MRI scan of the spine. Occasionally, if an individual cannot have an MRI scan, for example, has a pacemaker, another type of scan called a CT myelogram will be carried out instead. You may also require a neck X-ray where you will need to bend your head forward and back so that we can look for any abnormal movement (instability). page 2 of 8
What is an MRI scan? This is a simple and safe test, with the scans being produced using a technique known as magnetic resonance imaging. There is no radiation involved and no need for admission to hospital. The length of time spent in the scanner is usually about 10 minutes. Specific arrangements can be made for patients with claustrophobia, for example sedation or using an 'open' scanner. Why should I have a cervical laminectomy operation for cord compression? The aim of the surgery is to prevent further deterioration, i.e. to maintain the status quo and stop things getting worse. You are strongly advised to have the surgery if your surgeon has identified your spinal cord as being compressed and has recommended an operation. Unfortunately, further neurological deterioration over months to years is inevitable. Any improvement as a result of surgery is a bonus and only occurs in less than one third of those undergoing the procedure. The surgery will not benefit neck pain. What does the operation involve? The operation usually takes up to 2 hours and is performed under general anaesthetic whilst you are asleep. During the operation you will be lying on your front and an X-ray is used to mark the appropriate disc levels to be decompressed. The surgery is usually undertaken through a cut about 5-10cm in length at the back of your neck. This allows the surgeon to remove the bone at the relevant level. The surgeon may leave a plastic drain overnight following surgery that is removed by the ward nurse the next morning. A blood transfusion is only rarely needed. page 3 of 8
Are there any alternatives? A more common operation for cord compression is called an anterior cervical discectomy/fusion where the decompression is performed from the front as compared to a cervical laminectomy where the decompression is via the back. There are advantages and disadvantages to both approaches. Your surgeon will have decided to perform a cervical laminectomy for a specific reason. This may be because you may have: many disc levels of cord compression you are aged over 70 years have compression of the spinal cord from the back have compression of the spinal cord high in the neck (that can't be easily reached by going from the front) Are there any risks? As with any procedure there are risks you should consider. These include: A clot in the leg (deep venous thrombosis) and/or clot in the lung (pulmonary embolus) can occur (1 in 100) Dural tear/cerebrospinal fluid leakage can occur; the dura is the thin canvas sleeve that covers the spinal nerves (1 in 100) Nerve root injury; this could cause permanent numbness or weakness (1 in 100) Wound infection (1 in 500) Spinal cord injury/limb paralysis (1 in 200) for example from a blood clot or displacement There may be some additional risks either because of a specific medical problem that you otherwise suffer from, for example diabetes or age related page 4 of 8
Serious complications are uncommon. There are many steps that we take to try and stop complications happening and to reduce the impact of such complications when they do happen. Preparation for surgery At the Pre-operative Assessment Clinic the nurse will assess your state of health and will organise any necessary tests. This may include blood tests, urine tests, an ECG (heart tracings) and x-rays. Our aim is to start discharge planning at this appointment. We will ask you questions about your home situation. It is important for you to ask for any extra help that you feel you may need when you go home, so that plans can be set in place as soon as possible. This will help to avoid any unnecessary delays in you going home. Consent As with any procedure we must seek your consent beforehand. Staff will explain the risks, benefits and alternatives where relevant before they ask for your consent. If you are unsure about any aspect of the procedure or treatment proposed, please do not hesitate to ask for more information. How long will I be in hospital? You would normally be expected to go home the day after the surgery. page 5 of 8
What can I expect after the operation? There will be some pain in the area of the skin wound itself and also in your neck. Although we prefer you to stay in bed the night after surgery, you can get up to go the toilet. You will be seen by the physiotherapist on the morning after surgery who will ensure that movements such as getting out of bed are done correctly. There is usually no need for physiotherapy following discharge. You will need to attend your local GP practice for removal of skin wound clips or sutures at about 7-10 days following surgery. The ward nurse will give you further details. Driving is generally considered inadvisable in the early weeks. If you are overweight, you should consider losing weight as this will reduce the chances of spine wear and tear related problems in the future. When can I go back to work? If you work, you will require 6 weeks off. A sick note for work should be obtained from the ward nursing staff before you go home from hospital. You will also receive a letter asking you to phone the hospital to make an appointment for a follow-up clinic appointment for about 6-8 weeks following your surgery. At this appointment you will either see the Consultant, Registrar or Nurse Practitioner. page 6 of 8
Is there anything I should look out for when I go home? Painful, swollen calf Red and swollen wound Leakage from the wound Weakness in arms and/or legs Who should I contact if I have any concerns? If you have any concerns, please contact the ward you were discharged from, the consultant s secretary, or the neurosurgical nurse practitioner. Ward N2 0114 271 2896 If you develop severe shortness of breath, coughing, and chest pain, you may have developed a clot in the lung, and should 999 or go to your nearest Accident and Emergency Department. page 7 of 8
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