Cervical (Neck) Decompression and Fusion
Posterior cervical decompression is a surgical procedure performed through the back of the neck to relieve pressure over compressed nerves in the cervical spine region caused by inflamed spinal tissue or nerves, by removing portions of the cervical vertebrae. Dr. William Ryan Spiker is a fellowship-trained Orthopaedic and Neurologic spine specialist who treats conditions of the neck and back such as disc herniations, spinal stenosis, cervical myelopathy, and deformities of the spine. He believes in the thoughtful use of new technologies, including minimally invasive surgery and image-guided techniques for the betterment of patients. Dr. Spiker provides diagnosis and individualized management for neck pain in Utah. Contact Dr. Spiker’s team for an appointment today!
What is Posterior Cervical Decompression?
Posterior cervical decompression is a surgical procedure performed through the back of the neck to relieve pressure over compressed nerves in the cervical spine region caused by inflamed spinal tissue or nerves, by removing portions of the cervical vertebrae. Injury or wear-and-tear can cause parts of the cervical vertebrae to compress the nerves of the spinal cord, leading to pain, numbness, or tingling in the part of the body that the nerve supplies.
Posterior cervical decompression can be performed through a minimal invasive approach. It does not require cutting and stripping of the muscles from the spine region, unlike the conventional open spine surgery, which requires spine muscles to be cut or stripped.
Cervical Spine Anatomy
The spine is made up of 33 small bones called vertebrae and is known as the spinal column or vertebral column. It can be divided into 5 parts: cervical, thoracic, lumbar, sacral, and coccyx region. The cervical spine is comprised of the first 7 vertebrae (C1-C7) and supports the neck and the head. The vertebrae are protected by spongy vertebral discs present between them and is supported by ligaments that hold them together and surround the underlying spinal cord.
Indications for Posterior Cervical Decompression
Posterior cervical decompression is usually indicated for herniated discs, spinal stenosis, bone spurs, bulging discs, spinal injury, spinal tumors and when conservative treatment options do not provide relief.
Preparation for Posterior Cervical Decompression
You will have a preoperative assessment session before surgery. During your assessment, you must inform your doctor about any health conditions you may have, such as diabetes or bleeding disorders, and about any medications that you may be taking, such as blood thinners and over-the-counter medications. You may be asked to stop taking certain medicines for several days before the procedure.
Your doctor will explain the surgical procedure, its risks and benefits, and answer all your other surgery-related queries before the procedure. Blood tests, X-rays or other imaging tests may also be ordered to assess your medical condition.
Procedure for Posterior Cervical Decompression
The procedure is performed in the back of the neck under anesthesia with you lying face down. Your surgeon makes a small incision in the midline over your cervical spine region. The layers of neck muscles are separated using a retractor, and the affected nerve root is identified. The lamina (bony arch of your vertebra) may be removed (laminectomy) and the facet joints may be trimmed to reach the compressed nerve. Then, the bone or disc material and/or thickened ligaments are removed, relieving the pressure on spinal nerve structures, creating decompression. The neck muscles are brought back into their original position by removing the retractor. The incisions are closed with absorbable sutures and covered with a dressing.
Postoperative Care Instructions
You can expect your post surgery hospitalization to last up to 7 days. Full recovery from cervical decompression surgery can take an average of 5 weeks. You will be discharged with instructions that need to be diligently followed for a complete recovery, including:
- You will be prescribed pain medications to keep you comfortable
- You may be given a soft cervical collar to wear for comfort and pain relief for a couple of weeks
- Incision site care instructions will be provided to keep the incision clean and dry
- You may take a shower after 1 week if the incision is closed and well healed and not draining any fluid
- You need to call your doctor if you notice any swelling, redness, drainage, or increased pain at the incision site
- You will be instructed on sleeping posture, such as keeping the head of the bed elevated at 30 degrees with the use of pillows or by sleeping in a reclining chair
- You will need to avoid driving for a couple of weeks due to lack of head movement
- Walking activities are strongly encouraged to aid in recovery
- No overhead activities or strenuous activities and no lifting more than 15 pounds to avoid strain on the healing vertebrae for the first 1 to 2 weeks
- Follow-up appointments will be scheduled to monitor progress
Risks and Complications of Posterior Cervical Decompression
As with any surgical procedure, posterior cervical decompression involves potential risks and complications that may include:
- Leakage of cerebrospinal fluid (CSF)
- Spinal cord or nerve root injury
- Blood clot in the lungs or legs
- Spinal instability
- Neck or arm pain
- Further procedure
What is Posterior Cervical Fusion?
Posterior cervical fusion (PCF), a surgical procedure performed through the back of the neck, involves joining or fusing two or more damaged cervical vertebrae. The fusion of vertebrae is also known as arthrodesis. Sometimes, metallic plates may be used for fixing the vertebrae, this is also known as instrumentation.
Indications of Posterior Cervical Fusion
PCF may be employed for the management of cervical fractures, bone dislocations and deformities due to an abnormal curvature of the cervical vertebrae.
Posterior Cervical Fusion Procedure
The procedure is conducted in an operating room under general anesthesia. You will be made to lie face down on the operation table. A small incision is made over the center of the back of the neck. The muscles and the soft tissues are then retracted to approach the spine. X-ray imaging is employed to identify the affected intervertebral disc. The surfaces of the lamina of each vertebra to be fused are trimmed. This results in bleeding, which aids in rapid healing of the fused bones. In addition, small strips of bone graft taken from the pelvis are placed over the spinal column, which aids in the fusion of the bones.
Confirmatory X-rays may be taken to confirm the proper placement of the bone graft. Finally, the retracted muscles and soft tissues are placed in their normal positions and the wound is sutured.
Postoperative Care following Posterior Cervical Fusion
You may be discharged from the hospital within a week of the surgery. A neck brace is recommended for several months; however, this restriction may not be required if the vertebrae are fixed with a metal plate during the PCF surgery. You are initiated on a liquid diet, which is gradually changed to solid food depending on your recovery.
Physical therapy is recommended after 4-6 weeks of the surgery. Physical therapists help you perform routine activities without exerting any extra stress on the neck. Rest is advised as it helps in healing of the bone graft.
Risk and Complications of Posterior Cervical Fusion
Every major surgery is associated with potential complications. Some of the complications associated with posterior cervical fusion include:
- Complications related to anesthesia
- Thrombophlebitis (blood clot due to an inflammatory process)
- Non-union or pseudarthrosis
- Damage to the spinal nerves
- Problem related to bone graft
- Persistent pain
If you are experiencing neck pain, please contact the office of Dr. William Spiker, orthopaedic and neurologic spine specialist treating patients in Salt Lake City and South Jordan, Utah.