Cervical Stenosis and Cervical Myelopathy Surgery

Introduction

The narrowing of the vertebral canal in the neck area is called cervical spinal stenosis. This narrowing can occur as a result of a herniated disc or degenerative cervical pathologies. With the progression of narrowing, compression of one or more nerve roots (radiculopathy) or the spinal cord (myelopathy) can occur.

Neck pain, arm pain, sensory changes or in severe forms: muscle weakness, loss of balance or inability to perform fine movements such as fastening-unfastening buttons, etc.; are some of the clinical signs.

Clinical examination in combination with imaging such as cervical radiography or CT, MRI establish the diagnosis and analyze the type of surgical intervention needed. Accurate and early diagnosis is essential to perform the surgical intervention in order to prevent gradual paralysis.

Surgery

Mainly three surgical techniques are used for the surgical treatment of the above pathology.

• a) posterior decompression
• b) anterior decompression
• c) combined decompression.

Posterior decompression consists of expanding the vertebral canal by removing its posterior wall (laminectomy). This operation is performed with an intervention on the back part of the cervical spine in combination with posterior stabilization (posterior fusion).

Anterior decompression consists of removing the intervertebral disc at the level causing pressure on the spinal cord (discectomy), or removal of one or both cervical vertebrae along with the intermediate discs. Metal cylinders, which are filled with bone tissue (graft) taken from the patient's pelvis (autologous) or pre-prepared (processed) from a cadaver (allograft), are placed in their place.

In severe cases, the combination of the two above procedures is a necessary need to solve the problem.

General Guidelines

The patient stays in the hospital for 4 to 6 days after the surgery. In the first 24 hours, the head of the bed is allowed to be raised to facilitate the respiratory movements of the chest. Gradually, with the help of a physiotherapist, the rehabilitation protocol is followed, and general needs such as walking, sitting in a chair, etc., are performed. The surgical trauma should be checked after the bath.

The patient returns home when they feel comfortable and can manage daily activities. The patient may return to work after a period of 6 weeks after the surgery, always depending on the profession. For a period of 3 months, it is necessary to wear a strong cervical support to facilitate movements and to protect the surgery until the moment (third month) that the graft has fused.

Detailed guidelines are given regarding the return to daily life activities.

Complications

As with any surgical procedure, there is a risk of complications. They are rare, however, the patient should be informed before the surgery.

These may include:

• Complications related to anesthesia
• Infection (very rare).
• Nerve damage is a potential risk and may result in arm pain, numbness, or muscle group weakness. This complication occurs due to the new position that the nerve root takes.
• Leakage of cerebrospinal fluid may rarely occur, but if it does, it can cause headaches for a few days.
• Difficulty swallowing (Dysphagia) or voice hoarseness (Dysphonia) in the first days after surgery. (Rare and improve over the days).