The cervical spine, or neck, is a vital part of the body that supports the head and allows for a wide range of motion. However, conditions such as spinal stenosis, herniated discs, or degenerative changes can lead to nerve and spinal cord compression, causing pain, weakness, and numbness. When these symptoms are severe and non-surgical treatments fail, posterior cervical decompression and fusion (PCDF) may be recommended. This guide explains the procedure, its benefits, risks, and what to expect during recovery, accompanied by visual aids to enhance understanding.
At Endoscopic & Minimally Invasive Spine Specialists, we have extensive experience and expertise with posterior cervical decompression and fusion surgery and provide the highest-quality care in surgical and non-surgical neurosurgical care.
To learn more about posterior cervical decompression and fusion, call the office today or request an appointment online.
This guide will help you understand the condition, the procedure, its benefits, risks, and the recovery process.
What is Posterior Cervical Decompression and Fusion?
Posterior cervical decompression and fusion is a surgical procedure performed to:
1. Relieve Nerve or Spinal Cord Compression: By removing structures like bone spurs or ligaments that press on the spinal cord or nerves.
2. Stabilize the Spine: By fusing vertebrae together to prevent abnormal motion and maintain proper alignment.
The surgery involves two main components:
1. Decompression: Removal of the structures causing nerve and spinal cord compression, such as the lamina (part of the vertebra) and ligamentum flavum (yellow ligamentous soft tissue), in a procedure called a laminectomy.
2. Fusion: Placement of bone grafts and hardware, such as cages, screws, and rods, to stabilize the spine and promote the fusion of adjacent vertebrae.
Conditions Treated with PCDF
PCDF is commonly used to treat:
1. Cervical Spinal Stenosis: Narrowing of the spinal canal leading to nerve or spinal cord compression.
2. Herniated Discs: When a damaged disc presses on nearby nerves.
3. Cervical Myelopathy: Compression of the spinal cord causing weakness, coordination issues, difficulty walking and/or bowel, bladder, or sexual dysfunction.
4. Trauma: Fractures or instability in the cervical spine with or without blood clots causing stenosis.
5. Tumors or Infections: Abnormal growths or infections that compromise spinal stability or cause compression.
6. Degenerative Disc Disease: Age-related wear and tear leading to spinal instability and nerve compression.
Preparing for the Surgery
Pre-Surgical Evaluation
Before surgery, you will undergo a thorough evaluation to ensure you are a good candidate for PCDF. This may include:
1. Medical History and Physical Exam: To assess overall health and identify potential risks.
2. Imaging Studies: X-rays, MRI, or CT scans to pinpoint the location and cause of nerve compression.
3. Electrodiagnostic Tests: EMG or nerve conduction studies are occasionally needed to evaluate nerve function.
4. Pre-Surgical Clearance: Blood tests and evaluations by your primary care physician or specialists if needed.
Preparing for Surgery
1. Medication Review: Your surgeon may adjust or stop certain medications, such as blood thinners, non-steroidal anti-inflammatory medications, anti-rheumatic medications, steroids, or pain medications.
2. Lifestyle Modifications: Stop smoking and maintain a healthy diet to promote healing. Optimize your blood sugar if you are diabetic, and try to lose weight if you are obese to reduce your risks during surgery and improve your speed and quality of recovery after surgery, as well as to substantially reduce any infection risk.
3. Pre-Surgical Instructions: You need to fast the night before surgery and arrange for a ride home.
The Surgical Procedure
PCDF is performed under general anesthesia and can take up to 2 hours. Here is an overview of the steps involved:
1. Positioning:
- You will be placed face-down on a padded surgical table to provide access to the back of the neck.
2. Incision:
- A midline incision is made along the back of the neck to expose the cervical vertebrae.
3. Decompression:
- The surgeon removes the lamina (laminectomy) or other structures causing nerve compression. This creates more space for the spinal cord and nerves.
4. Fusion:
- Bone grafts are placed between the affected vertebrae. These may come from your own body (autograft), a donor (allograft), or be synthetic. At EMISS, we preferentially utilize synthetic bone graft to reduce the likelihood of contamination and maximize the effects of the graft material.
- Metal screws, cages, and rods are used to secure the vertebrae in place and stabilize the spine while the bone graft fuses.
5. Closure:
- The muscles and soft tissues are repositioned, and the incision is closed with sutures and surgical adhesive.
Recovery After Surgery
Hospital Stay
- Most patients are easily able to go home the same day. However, depending on your general health and severity of your problem, you may require a short stay in the hospital after surgery.
- Pain management includes medications and, in some cases, a cervical collar for support and mental reminder to minimize neck motion.
- Physical therapy may begin the day after surgery.
At Home
1. Wound Care:
- Keep the incision site clean and dry.
- Follow your surgeon’s instructions for dressing changes.
2. Activity Restrictions:
- Avoid heavy lifting, bending, or twisting for several weeks.
- Limit driving until cleared by your surgeon, who may allow return to driving 1 day to 4 weeks after surgery.
3. Physical Therapy:
- Physical therapy focuses on improving strength, range of motion, and overall mobility.
Long-Term Recovery
- Fusion typically takes 6-12 months to fully develop.
- Regular follow-ups with your surgeon will monitor progress.
- Imaging studies may be performed to confirm successful fusion.
Benefits of PCDF
1. Pain Relief:
- Reduction or elimination of neck, arm, or hand pain caused by nerve compression.
2. Improved Function:
- Enhanced ability to perform daily activities without limitations.
3. Stabilized Spine:
- Prevention of further spinal instability or deformity.
4. Slowed Progression of Neurological Symptoms:
- Stops or slows worsening of conditions like myelopathy.
Risks and Complications
As with any surgery, PCDF carries potential risks, including:
1. Infection:
- Rare but treatable with antibiotics or additional surgery.
2. Bleeding or Nerve Damage:
- While uncommon, these complications can occur.
3. Hardware Failure:
- Screws or rods may loosen or break over time
4. Non-Union (Pseudoarthrosis):
- The bone graft may not fuse properly, requiring further surgery.
5. Adjacent Segment Disease:
- Degeneration of spinal segments above or below the fusion site.
Frequently Asked Questions
1. How long does the procedure take?
- PCDF typically takes 1-4 hours, depending on complexity, your general health, and the number of levels or presence of prior surgical scar tissue or hardware, as well as the expertise and experience of your surgeon.
2. Will I need a neck brace?
- Some patients may benefit from a cervical collar for additional support or comfort during recovery.
- Your surgeon will provide the appropriate collar for you and give specific instructions for when, how, and how long to wear and remove it.
3. When can I return to work?
- Recovery time varies, but most patients return to light work within 2 weeks and full activities within 3-6 months.
4. How successful is the surgery?
- PCDF has very high success rates for relieving pain and stabilizing the spine when performed for the right indications.
Contact EMISS to Schedule Your Procedure
Posterior cervical decompression and fusion is an effective surgical option for relieving nerve compression and stabilizing the spine. While the procedure carries risks, careful planning, a skilled surgical team, and diligent postoperative care can lead to significant pain relief and improved function. If you are considering posterior cervical decompression and fusion, consult with your spine surgeon to discuss your specific condition and treatment options. Understanding the procedure and its benefits can help you make an informed decision about your care.
To learn how you can benefit from posterior cervical decompression and fusion surgery and patient-centered care your neurosurgical and spinal problems, call Endoscopic & Minimally Invasive Spine Specialists today, or book an appointment online.
