Cervical (Neck) Spine Surgery

Information for patients undergoing cervical (neck) spine surgery

Admission to hospital can be a daunting experience for most people. The following information is designed to give you information about your stay at The Walton Centre and what to expect. This information is intended as a guide and may vary depending upon your individual requirements for further information please see patient information on British Association of Spine Surgeons website (spinesurgeons.ac.uk/Booklets)

The Walton Centre is a regional unit that admits patients 24 hours a day depending upon the urgency of their condition. Although every effort is made to ensure your admission goes ahead as planned, occasionally it is necessary to cancel planned surgery at short notice.

Why do we perform cervical spine surgery?

The surgical procedure that you are to be admitted for depends on your specific requirements, but this information is for those who are to have surgery performed in the cervical spine (neck area).  For specific conditions or terms that you may have heard your Surgeon use and that may or may not be relevant to you please see the end of the page.

How does your spine normally work?

Spinal Column

The spine is composed of small bones called vertebrae, which all sit on top of each other to form your spinal column. These bones get bigger as you get further down the column in order to support the increasing weight of your body, and are largest in your lower back area.

The neck area is made to be very flexible so we can move our head and see around us, this flexibility increases the chance of wear and tear to this structure.

The spinal column forms a bony cylindrical tower, and down the centre of this runs the channel for your spinal cord.  The bony spinal column protects the delicate spinal cord, and this is helped by the presence of:

Ligaments: Strong elasticated type tissue that helps to hold all the bones in place; long ones that run the whole length of the spinal column and short ones that are in between each of the bones.

Joints: These are sections of the bone on each vertebrae, that interlock to keep the formation of the spine.  They have surfaces that rub on and the interlock with the bones above and below.

Intervertebral Discs: These are soft cushions of tissue which sit in between each of the bones in your spinal column to stop the bones rubbing together and they act as shock absorbers.  They have an outside ring of tough tissue called the annulus fibrosis and a softer centre called the nucleus pulposus.

Spinal Cord

As we have already mentioned the spinal cord and nerves run through your spinal column. Your spinal cord acts in a similar way to a telephone exchange, passing information from your brain to most parts of your body and back again. At the level of each bone (vertebra) your spinal cord sends out a nerve, one on the right side and one on the left side. These nerves contain millions of nerve fibres, to transmit messages to and from the body. They send messages to tell us about the sensations we are experiencing such as pain, temperature and the ability to know where our limbs are without looking. They also send messages that allow us to move our bodies.

The spinal cord and nerve roots are surrounded by a fluid called cerebrospinal fluid (CSF) and this is contained within a membrane, or covering, called the dura mater, rather like the thin layer that covers a boiled egg allowing this to protect all the structures.


What can problems in the cervical spine cause?

Problems in the cervical spine can cause various symptoms depending on which nerves they press upon.

They can either cause problems on one individual nerve, and/or affect the spinal cord as it travels past that area.

In the neck area, problems can cause symptoms in all of the limbs.

It may seem a bit strange, but if you think your spinal cord acting in a similar way to the London underground train system.  Your spinal cord is made up on millions of nerve fibres all passing messages to particular parts of your body, like the tunnels of the underground, all carrying trains of people to various stations. If there is a problem at one station, it can either affect just that one station or it can affect that one station and all of the others after it, as trains cannot pass through.  In the same way, a problem at one level of your spine can affect just those nerves at that level, or it can affect that one level and all of the others after it, as the messages are not able to travel past.

This means that there can be many different symptoms. Usually, any pressure on the nerves and/or spinal cord in the neck area can cause:-

  1. Pain, most often in the arms or hands, but can be in the legs.
  2. Weakness in some or all of the limbs.
  3. Possibly some tingling or unusual sensations
  4. Stiffness in the limbs, especially the legs causing problems with walking.
  5. Problems with coordination in some or all of the limbs.

What does surgery involve?

In general, surgery allows the problem area which is causing the pressure on the nerves or spinal cord, to be removed or reduced in size, with minimal disturbance of bone and tissue. This is achieved with a microscopic surgical technique.

Surgery involves the Surgeon gaining access to the problem area in your spine through a wound in your neck, this all done whilst you are asleep under general anaesthetic.  Where your wound is, and its size, depends on your particular surgery. Some surgical procedures in the neck require a wound at the back of the neck, some procedures require a wound at the front of the neck, and again this will depend upon your procedure. A microscope is often used for the surgery to give a better picture of the tissues and to minimise the disturbance to the surrounding structures, improving accuracy.

Some patients require a graft, cage or instrumentation (screws and rods or plates) as part of their surgery. If this is to be a part of your surgery then your Doctor will have already discussed this with you.

A graft is an addition of either your own bone or donor bone (bone from someone else), into the operation site to stabilise the bones of the spine.   When bone is removed during surgery to allow access to spinal cord and/or nerves or if your bones normally have too much movement in them, they can become unstable.  The bones then sometimes need to be packed in order to keep the structure stable and allow fusion of the spinal bones (the spine to become solid and stable) following surgery.  The bone used to pack the space is your own, taken from your neck during the surgery, for example if you have too much bone causing compression to the nerves then this is removed but recycled and used to pack the structure and help fusion at the correct place. Donor bone is accessed from a source that has undergone all the rigorous testing called DBM. DBM (demineralised bone matrix) is a product made of bone fibres that have been shown to provide scaffolding for your own bone to build upon.

Very occasionally bone may be taken for fusion from the front part of your pelvis, just behind your hip (during the operation), but this used very rarely.

A cage is made of metal or carbon fibre and is used as an aid to stabilising the structure.  It is a small permanent, internal implant in your spine.  It supports the structure of the spine whilst it heals and is left in place.

Some patients may need some form of implant, these can be special screws, rods, wires, plates or pieces of metal that are designed to support the spine from inside you.  If needed, they are attached to various parts of the spine during surgery, and usually permanently stay in place.  Your Surgeon will explain the details to you if you need any of these for your surgery.

Why have surgery?

The following information is to help you understand what we are offering you and why.  Please remember, agreeing to surgery is your decision.  The job of our team is to present you with the facts and options as we see them.  You have the right to change your mind at any point in time, if you wish for further explanation at any time please just ask one of the staff.

Surgery is usually performed in order to try and prevent any further deterioration in your symptoms. In some cases it is to try to give you relief from any pain you may be experiencing. However, please understand there is no guarantee that there will be any recovery of any weakness or numbness that you have had prior to surgery.

This is because when the spinal cord and/or nerves have been under pressure for a long time, often over many years, taking the pressure away does not mean that the underlying damaged nerves/spinal cord can fully recover.

Alternatives to surgery

The other options for treatment are:-

  1. Monitor your condition to see if it remains stable and that your symptoms do not get any worse.  It is likely that if you have a condition that is progressively getting worse that it will continue to do so without surgery.
  2. Managing your symptoms, this can include physiotherapy and medication for the management of your symptoms for example, pain and muscle spasms.
  3. In some cases osteopathic treatment or injection therapies may help.
  4. You may choose to do nothing and accept the situation.

What can you expect from surgery?

The primary reason for surgery is to prevent further deterioration in your symptoms, NOT to improve any symptoms you may already have.

For those with a lot of pain it can help with relief of pain.  It has less effect on any sensory changes you may have, such as pins and needles and numbness.

It is unlikely to improve any of the symptoms you already have for example, weakness and stiffness in the limbs.

If there is some muscle wasting (loss of muscle bulk) then this is usually irreversible but this may be improved by a little focused exercise after successful surgery.

Risks of surgery

All the risks will be discussed with you prior to your surgery and although they are not common you should be aware that there is the potential for them to occur.

  1. Risk from anaesthesia (being put asleep for your surgery)
  2. Risks from positioning during surgery and equipment used, this can include skin injuries, eye complications, most severely blindness but this is exceptionally rare. Special gel pads/protection are used during surgery to minimise the risk of these complications. Diathermy pads are used which is an adhesive pad placed on the skin, usually the thigh area, to minimalise heat build up, this can cause skin irritation and in exceptional and very rare cases a skin burn.
  3. Small risk of persistent or increased pain.
  4. Risk of injury to the nerves (1 out of 100 cases, but can occur in 10 out of 100 cases if surgery has been performed at the same level before – re do surgery) or spinal cord causing weakness or numbness. In the extreme, this can result in total paralysis (unable to move from the neck down) but this is an exceptionally rare complication.
  5. Leak of spinal fluid, occurs in fewer than 5 out of 100 cases, and is more common if you have had surgery in the same place before. It is often repaired during surgery with special glue or a patch. In a few cases it may mean a further operation is needed but the risk of this is less than 0.05%.
  6. Infection of the wound and/or any implants that are used (screws, plates and cages) which includes infection from MRSA bacteria (infection with MRSA is rare). Superficial infection can occur in 4 out of 100 cases. Deep wound infections can occur in 1 out of 100 cases and are more difficult to treat and may need further surgery or long courses of antibiotics, initially by intravenous infusion, Any infection can result in Sepsis but again this is exceptionally rare.
  7. Bleeding or haematoma (collection of blood), may need a return to theatre for removal of the clot or to stop bleeding. Damage to major blood vessels resulting in death 1 in 10,000.
  8. Wound drain problems, requiring removal in theatre, whilst under anaesthetic, which again is very rare
  9. In patients having a graft, cage or any type of implant (rods, screws etc.) there is the potential for any of these to fail (5 out of 100 cases) and/or move out of the correct position.
  10. The level of surgical intervention, not fusing causing pain which may need further surgical intervention, again this is exceptionally rare.
  11. Problems at the levels above or below the surgery, due to the level either side of the surgery being fused, with bone graft and/or screws and rods, this can sometimes put pressure on the level above or below the surgery, causing problems over time.
  12. Not improving symptoms, or symptoms reoccurring.

As already mentioned complications are rare, but we have a duty to inform you of all possible complications, even though lots of them are very rare. If you are worried about any of the aspects surgery you will have the opportunity to discuss any concerns prior to surgery and following your hospital admission.

Additional surgery

In a few cases surgery from only the front or the back of the neck may not be enough.  There will be a minority of patients who require surgery from the front and the back during the same operation, or split over two separate operations.

Surgery at the front of the neck is usually performed through a horizontal incision to the side of the neck.

The information enclosed in this booklet is appropriate for those who need surgery at the front or the back of the neck.  Your preparation for surgery and recovery afterwards will follow the same path.

There are additional risks to take into consideration if you need surgery at the front of your neck; these are in addition to those mentioned on the previous page.

Again, please be aware that the risks will be discussed with you prior to your surgery and although they are not common, you should be aware that there is the potential for them to occur.

  1. Sore throat/swallowing problems due to manipulation of the throat structures during surgery to allow access to the front of the spine (this should settle down within a few days of surgery)
  2. Vocal cord problems e.g. hoarse voice (this should settle down within a few days of surgery)
  3. In theory there could be injury to the nerve for sweating, eye lid and the pupil (Horner’s syndrome), although this is exceptionally rare.

Pre-operative assessment

It is important, if you have any changes in your pain or symptoms and also if you develop any new medical conditions or are unwell, you speak to spinal nurses or your consultant’s secretary at the earliest opportunity but definitely prior to attending for your admission.

In order to gain the information we need to ensure your safety during your surgery, once you have agreed to surgery you will be required to complete a pre-operative assessment online. You will be provided with the information you need on how to complete this. The information you provide will be reviewed by one of the pre op nurses. Once this is done you will be contacted to explain the next steps that will be applicable to you and the procedure you are undergoing.

Your admission will not be arranged until you have completed your pre-operative form as this is important in deciding if you need any additional assessments. It is essential we ensure your maximum safety for surgery. If you are having any problems completing the on line documentation then please inform the pre op nurses.

For some patients you will only need to attend for some blood to be taken for testing, and routine swabs. Some patients will need to be spoken to by phone to clarify medical details, some will need to come in to clinic to be seen and examined.

It is very important that you complete your pre-operative questionnaire with all the details as accurately as possible, as inaccurate information may delay your surgery

If you do have to attend for an assessment it may include:-

  1. A member of the team will discuss your medical history (your past operations and any medical conditions you may be suffering from) with you and you will be examined.
  2. You may be reviewed by an Anaesthetist; he/she will have a chat with you and discuss any relevant medical history and explain what having an anaesthetic will involve.
  3. You will have some blood tests performed.
  4. If any x-rays or a heart trace (ECG) are required these will also be done.
  5. Your medication may be prescribed; it would be helpful if you could bring with you any medication that you are taking or a list of your medication and doses. It is very important that you tell us about all your medication, including all prescribed medication, medication you buy and any herbal remedies. It is especially important that you tell us about any medication that may thin your bloods.

An appointment will be organised for you and sent to you if you are required to attend for this.

Some Patients may not have a pre-operative assessment of any type, this can be for many reasons, for example, you are admitted urgently or as an emergency and there is no time for all of this to be completed. This is not a problem, because everything you need will be done the day you are admitted. Your surgery in this situation is normally the following day. You will not go home overnight.

Please be patient whilst we complete all of our assessments. It is important that we ensure everything is completed to ensure your safety. Occasionally we need to postpone surgery if your pre-operative assessment indicates that there are more tests or assessments needed before we proceed with your surgery. We understand that this is frustrating, but we will not proceed until we have all the information we require to ensure your maximum safety.

Admission to Hospital

You will be able to eat and drink up to midnight the night before your surgery and drink clear water only up to 6am on the morning of your surgery. You will then be able to have sips of water only from 6am until you go for your operation. This will be clarified for you prior to your admission. Most patients will be admitted the day of their surgery at approx. 07.15 having followed the fasting instructions above.

It is advisable not to bring any valuables with you into Hospital as the Hospital does not accept any responsibility for their safety.

When you arrive you will be seen in an admission area and then informed which ward you will go to after your surgery

The day of surgery

You will be kept fasted (nothing to eat or drink) and need to wear a theatre gown, we would ask that you have a bath or shower prior the morning of your surgery before you leave home.  

Your details will be checked with you on the ward before you go to theatre.  You will be wearing a wrist band and have to answer a list of questions, for example, your name, date of birth and confirm that you have removed all jewellery, underwear and make up etc.

You will be collected for theatre and taken to the theatre reception area where the Nurse will check your details again; whilst this can appear repetitive it is all done to ensure your safety. From there you will be taken to the Anaesthetic room, where your details will be checked again. We have a robust safety check list which includes asking you to confirm your symptoms, which side of the body and where you experience them, do not be concerned, this is for safety only and not because of any queries about your surgery. Once this is done the Anaesthetist will give you your anaesthetic medication and once you are asleep you will be taken into theatre and surgery will be performed. The surgery will be performed by the Consultant or one of his team. It is common for x-rays to be used in theatre to assist the Surgeon with checking the correct position of the neck bones

After surgery you will be taken into the recovery room where you will be monitored whilst you wake up from your anaesthetic, and you will be made comfortable for your transfer back to the ward.  Occasionally some patients may need to spend a short time in the High Dependency Unit / Intensive Care Unit, although this is rare and is usually only for those who require additional monitoring due to pre-existing conditions, for example, previous heart problems or because of having extensive surgery.   This decision is made depending upon individual circumstances.

You will be transferred back to the ward after spending approximately 1-2 hours in recovery.  On return to the ward you observations i.e. blood pressure and pulse, will be checked regularly, as will your wound and your limb power and movement. 

An intravenous infusion (drip) will be in your hand until you are awake enough to eat and drink again.  You will be able to have sips of water a few hours after you return to the ward and then increase this as you feel well enough.

Wounds at the back of the neck can be uncomfortable and your pain may be controlled with injections initially, unless you prefer tablets, and then the following day you will be able to have tablets.  You will be encouraged to move around the bed as much as possible and if you feel well enough you will be able to get out of bed to pass urine.

Some patients may have a PCA, but this varies, depending upon the procedure you are having performed.  A PCA (patient controlled analgesia) is a machine that has a button on a hand set that you control and you can press this when you want some pain killing medication.  With each push of the button you give yourself a dose of painkiller (analgesia) through a small drip tube in your hand.  This does have a safety override, so that you cannot give yourself more than a set dose already programmed into the machine regardless of how many times you press the button.

Some patients may need a wound drain, this is a small plastic tube that is positioned under the skin and comes out into a plastic collection device, to drain away any excess fluid. This is usually held in place by a small stitch. This is usually easily removed by removing the stitch and gently pulling the tubing out from under the skin. It is usually removed the day after surgery. In exception circumstances this may need to be removed with a further operation but this is an exceptionally rare requirement.

The day after surgery

In most cases the day following surgery, your drip will be removed and your wound will be checked.  If you have not already been out of bed then most patients will be able to get out of bed the day after their surgery and will be encouraged to move around.  It is important that you are out of bed and walking around as quickly as possible; this helps to prevent complications and helps you recover faster.  Your wound will be uncomfortable but the more you are able to move your neck the easier it will become.

The Physiotherapist may see you to explain correct posture and exercises that you will need to do.  Not everyone needs to see a Physiotherapist, so a copy of these exercises is enclosed in this booklet, so you can do them at home.  You will need to bring this booklet into Hospital with you that you know the exercises you should be doing and so that if you do see a Physiotherapist they can complete any individual details for your exercise programme whilst explaining it to you.

Some patients may require an x-ray of your neck the day after surgery, some patients may need to wear a neck collar, this depends on the type of surgery performed. The medical staff will make this decision of each individual patient.

One of the Medical/Nursing team will check how you are managing.  Following this you will normally be able to go home in the afternoon.

For the majority of spinal surgical procedures, it is quite normal practice to go home the day after your operation.

Occasionally those who have had more extensive surgery may need some extra time in Hospital to recover, this is often just an extra day and is not usually more than a few extra days.

Pain medications

You may be taking 2 types of medications for pain, many patients come in for surgery having taken pain medication for a long time, such as Gabapentin, Pre gabalin, Amitriptyline, Duloxetine, or opiod based medication e.g morphine etc. Your doctor or specialist nurse may recommend, following your surgery, that you take a strong opioid medication alongside other painkillers such Paracetamol and your usual medication. This is to relieve the additional pain that your injuries, illness or surgery has caused.

When you are discharged, as well as your normal medication, you may be given strong opioid medication to take home. It is important that you do not exceed the maximum dose prescribed for you. It is also important that you do not take any other painkillers that have not been prescribed by the hospital at the time of your discharge. This may result in you having too much pain medicine and cause the risk of severe side effects.

If you were not already taking opioid medicines before admission to hospital, you should not need to take them for a long time. The additional pain medication, prescribed whilst you are in hospital, is only intended to be short term. As you recover and your pain reduces you will be able to slowly reduce taking the medicines.

Any medication you were taking prior to surgery should not be stopped suddenly and once you have recovered from surgery, after a few weeks, as you pain settles, discuss with your GP a reducing regime for your medication You should ask you GP to review your medicines to ensure you are not taking them longer than necessary and also to ensure they are reduced safely as abrupt stopping of some medications can produce side effects.

Discharge home

Getting home
Please arrange for a relative or friend to collect you. You will not be able to drive or use public transport. You can go home by taxi if a member of your family or friend can accompany you. If you cannot get transport arranged then we can arrange hospital transport, however travelling with a relative or friend would preferable if you can organise this.

Medication can be organised for you to take home, if required. Unfortunately, if we arrange medication from our pharmacy then this can mean you need to wait until later on your discharge day for it to arrive.

Your stitches/clips will be due to be removed approximately 7-10 days after your surgery and most patients made an appointment to get this done by their GP Practice Nurse. If you not have access to this then a District Nurse can be organised to check your wound and remove your stitches.

Some Surgeons use dissolvable stitches and your wound will need to be kept dry for 7-10 days. Some of these stitches need to be trimmed at the ends, but the nursing staff will advise you before you go home.

If you need a District Nurse then the date of your District Nurse visit will be given to you before you leave the ward. Please make sure that if you are not going home to your usual address and you are going to stay with someone else, you inform the staff to ensure that the District Nurse comes to the correct address. Please note, District Nurses can call at any time during the day.

Wound Care
Should you have any problems with your wound after your surgery, even if your GP or District Nurse are managing this, it is very important that we are also informed as we may need to monitor your more closely. We would like you to contact us if there is any redness round the wound, wound leakage, or you have a temperature.

Please phone either:-
Spinal Nurses on 0151 556 3424
Tissue Viability Team on 0151 529 5599

You can bath or shower, but please aim to keep the wound dressing dry, until it has healed and any sutures/clips have been removed.

What to expect
Again, this will depend upon the type of surgery you have had but here are some general things to expect:-

You will need to remember that surgery of this type is most often performed to prevent deterioration in your symptoms rather than make you better. You should expect this and consider any improvement you may get an added bonus. Some patients do notice some recovery but this can take many months and in general we would expect it to be approximately 12 – 18 months until you reach your full recovery potential.

It is not unusual for you to get increased pain or altered sensation or changes in the strength and coordination of your limbs for a few days, weeks and even months after surgery as your spinal cord and/or nerves recover from your surgery. It is important that you stay mobile and continue with your physiotherapy exercises following discharge. Some patients will experience a flare up of arm pain of symptoms approx. 7 -10 days post-surgery, this usually settles over time, but it is not unusual to get fluctuations in pain/symptoms over many weeks/months.

Remember that you have had an operation and it is usual to feel tired after this. Pace yourself and gradually build up your level of activity. Doing small things often, rather than all in one go is more sensible. You should progressively return to your normal daily routine as quickly as possible. You can undertake all the usual activities of daily life as you feel comfortable this includes walking, shopping, driving and sexual activity

Exercise will help your recovery i.e. walking and swimming, but gradually build your level up. If you were not doing much exercise before surgery, then you are going to need to gradually introduce it after your surgery. You should be up and about when you go home. Staying in bed is not advised and will not help your recovery. Be guided by yourself and be sensible, pace yourself and build your activity up gradually, tackle things in short sessions rather than trying to do too much in one go.

Research has shown that patients who return to normal routine as quickly as possible make the best recovery. You should progressively return to your normal daily routine as you continue to recover. You can return to work as soon as you feel you can cope even if you feel uncomfortable. Heavy lifting should only be performed in the correct way and should be avoided for the first three months.

As we have already mentioned, take your time and pace yourself, allow your body the time it need to recover

Surgical stockings
You should wear your surgical stockings for up to 6 weeks post-surgery, if your mobility is restricted or 2 weeks if you are fully mobile to reduce the risk of DVT (blood clots in the legs), and we advise not to fly for 6 weeks post-surgery, again due to the risk of DVT

You can drive when you can have a full range of movement and you must have full movement to allow you to have full control of the car, this includes being able to do an emergency stop. This is usually a few weeks after surgery.

You can return to work when you feel able and this can depend on what your job role involves. Those with desk based roles may feel comfortable to return to work 4-6 weeks post-surgery, but would need to be able to get up and move around to prevent stiffening in the neck area. Those with more manual jobs may need to wait the full 3 months before being able to return. Please discuss this with your nurse specialist or medical team if you are unsure.

When will we see you
You will be sent an outpatient appointment for approximately 3 months following surgery by post to either come and see us, or for us to speak to you by phone, so we can check you are recovering well. Here you will be seen/spoken too by either a doctor or a nurse specialist.

Remember that as your nerves try to recover you will notice unusual sensations and feelings in your body. Should you be concerned then feel free to phone us for advice. If you have any queries please do not hesitate to contact the spinal nurses on the advice line 0151 556 3424. Please leave your name and telephone number clearly on the answer machine so we can call you back. We try to answer the messages every working day. We work Mon- Fri 8am-6pm, we do not work weekends. We do spend a lot of time on the wards and in the out-patient clinics seeing patients, so please be patient, we will call as soon as we can.

Physiotherapy following cervical spine surgery

This information is intended to answer the most commonly asked questions. Any further enquiries can be directed to the Physiotherapy department.
On your first day post operatively, it is perfectly safe to:
• Be up and walking around.
• Perform daily activities such as dressing and washing.
• Spend time sitting out in your bedside chair, regularly changing your position is advised.

General advice
It is safe to continue with all regular activities such as cooking, cleaning, shopping and sexual activity.

You can sleep in whatever position is easiest for you.

You may continue to have some neck/ arm discomfort or changes in sensation especially for the first 12 weeks, this is normal. Often this type of surgery is performed to ensure symptoms do not get any worse. Your medical team will have discussed this with you pre procedure.

There is no evidence to say that returning to activity and exercise leads to any adverse effects or the need for re-operation.

There is no restriction in bending forwards to pick up light objects or putting on your shoes and socks. We think it is sensible to avoid heavy lifting where possible to begin with. You can resume lifting when you feel able to do so. There is no given weight limit that we advise because everyone has their own usual capabilities. You can gradually increase the amount you do until you are back to your typical day to day routine.

You can return to driving as soon as you can sit comfortably, perform an emergency stop and that you feel safe to do so. This is a self-certification, meaning you decide if you are safe.

Returning to work and normal activities will help your recovery and you should aim to do this as soon as possible. People who return to work sooner have been shown to have better outcomes. You can return to work as soon as you feel you can cope, even if your back is still uncomfortable. You may wish to grade your return to work. It may take slightly longer to be able to return to a more ‘manually heavy’ job. It is normal to feel tired when returning to work after a period of sickness absence. You should plan to pace yourself and take regular breaks.

General activity and exercise has been shown to be safe in this patient group and indeed is beneficial for your overall health. We have included an exercise programme however general activities that you may already enjoy have been proven to be as effective therefore you should look to gradually resume these. For example; hiking, swimming, cycling, jogging, yoga and Pilates. Keeping a record/ diary may help you in guiding your progress. Some discomfort is normal when re-commencing activity; you should work within reasonable limits. Lower intensity exercise should be started first progressing to higher intensity over a period of weeks.

You can also safely return to recreational sports such as football, cycling or golf in a gradual manner. For specific advice, with regards to contact sports/ extremes of exercise such as rugby, kick boxing or body building, this should be discussed with your medical team.

Exercise Programme
Aim to do these exercises once per day. These can be started straight away; however a short delay in commencing them has not been shown to have adverse outcomes. Begin them when you feel ready. You can perform them several times per day ensuring that you pace yourself. Start gradually with a low number of each exercise and increase as you are able. These exercises can be complemented by general activity that you enjoy as previously mentioned. It is okay if you miss a day, or have a day off, to let your body rest if you feel this is needed due to expected aches and discomfort.
The following exercises are taken from Physio Tools General Exercises. Use with permission from Physio Tools Ltd.

Exercise programme



Bend your head forward until you feel a stretch behind your neck.  Hold approx. 10 secs.  Repeat 10 times.




Bend your head backwards as far as is comfortable. Hold approx. 10 secs. Repeat 10 times.




Turn your head to one side until you feel a stretch.  Hold approx.. 10 secs.  Repeat to other side. Repeat 10 times.




Sitting straight backed, push your head back against a firm surface.  Pull your chin in, keeping your neck and back straight (not tipping your head forwards).  Hold at the end position and feel the stretch in your neck.



Sit or stand

Roll your shoulders in both directions. Repeat 10 times.



Sit or stand

Lift both arms above head up letting the thumb lead the way. Repeat 10 times.



If you have any queries, before or after your surgery please do not hesitate to contact us to speak to your GP:-

Spinal Nurses
Tel: 0151 529 8853

(this is an answer machine, please leave a name and a telephone number, we aim to answer the answer machine on a daily basis but due to work commitments sometimes this is not possible)

Tel: 0151 529 5451

Secretary to your Consultant:
Tel: 0151 525 3611 and ask for your Consultant’s Secretary

All references used in the formulation of this information are available via The Walton Centre website or on request

Glossary of terms

Investigations and Tests


This is a picture taken with the use of x-rays.  These can be very helpful in showing if there is an abnormality in the structure of movement of the bones of the spine.

MRI Scan

This is a scan that uses the magnetic fields of the cells in the body. It can provide very detailed images of both head and spinal structures, especially structures like spinal cord, fluid cavities, spinal discs and channels nerves travel through.

It requires the person having the scan to lie still in the scan tube for approximately 30 minutes. You need to remain as still as possible as movement can distort the images produced and make it difficult to see structures clearly.

CT Scan

This type of scan is useful for giving accurate pictures of the structures within the spine, especially detail of the bony structures.  It uses x-rays in a particular way to form the pictures.


This is performed in the x-ray department.  A dye is inserted into the spinal canal.  The patient is moved on a special table and x-ray pictures are taken of the dye as it flows up and down the spine.  It can show if there are any blockages, or areas where the dye cannot flow properly and is often used if people cannot have an MRI scan.


Medical conditions of the spine and nerves


Spinal stenosis is when the spinal canal is too narrow and the spinal cord becomes too tight in the narrowed space.




This is damage to the spinal cord from pressure that causes difficulty with movement and feeling in the arms and legs. The pressure on the spinal cord squashes the spinal cord fibres and does not allow the messages to be passed through properly.


This is the name given to problems, for example pain or weakness that occur as a result of pressure on a particular individual spinal nerve root (rather than multiple different nerve roots).



Degenerative changes in the joints of the spinal column caused by chronic wearing away of the spinal structure, usually as a result of osteoarthritis.


Abnormal curvature of the spine.


These are types of bone spurs/projections.  They usually form along joints in the spine and only cause problems if they put pressure on nerves or spinal cord.  They are as a result of the natural process of age and the resulting wear and tear on the spine.


A fluid filled cavity.


This is the development of a fluid filled cavity within the spinal cavity within the spinal cord. This can be associated with other conditions or the result of trauma. The spinal cord around the cavity can become compressed as the fluid filled cavity expands.


Types of operations; surgical procedures


This is a surgical procedure to remove the lamina and spinous process.  Both these are parts of the bone that encircle the spinal cord that are at the back of the bony spinal column.  This is done in order to provide access to the spinal cord and nerves for surgery.

It is also done to release pressure put on the spinal cord and/or nerves by the lamina (bone).


This is a procedure where one side of the spinal column is scored creating a hinge affect and the other side is opened slightly to form a space.  The space is held open by wedging the hap and this creates more space within the spinal column without removing large sections of bone.  This expansion of the spinal canal gives the spinal cord/nerves more space.

Skip laminectomy

Same a laminectomy with this performed at some levels, combined with partial laminectomies at other levels, taking only one half of the bone away. Some levels are not touched and left complete thus ‘skipped’.


This is a procedure where one side of the spinal column is scored creating a hinge affect and the other side is opened slightly to form a space. The space is held open by wedging the gap and this creates more space within the spinal column without removing large sections of bone. This expansion of the spinal canal gives the spinal cord/nerves more space.


Removal of one of the bones of the spinal column (vertebra).  A bone graft is usually put in place of the removed bone.  Sometimes the addition of metal plates/rods and screws is needed whilst the bone fuses into place.


This is the name given to the surgical procedure to remove part of the facet joint of the vertebral column.  The facet joints are on each side of the vertebrae, just by where the nerve root comes out of the spine.  Sometimes these can become too big (especially as we get older) and cause pressure on the nerves lying next to them.

Removal of a portion of one or more vertebra and the adjacent discs and replacement with bone and instrumentation (screws and rods
and/or cages)


This is when the cause of any pressure to the spinal cord and/or nerve roots is surgically removed.  They are decompressed, for example by nibbling away any bone or ligament or disc that is pressing on the spinal cord or nerves.


The addition of bone and/or metalwork to hold the spinal column in a position until they become solid, by fusing overtime.  This is implanted internally during surgery and is usually not removed.  Sometimes special cement can be used to help fuse the bones.


This is a surgical procedure when overlying bone is drilled away from the nerves that run underneath.  This is to release any pressure the bone is exerting on the nerve roots lying underneath it.  Basically bone is drilled away to make the hole the nerve runs through bigger and stop it getting squashed by the bone surrounding it.



  • Last Updated:
    01 July 2022
  • Review Date:
    01 February 2024
  • Author:
    Keren Smallwood
  • Summary:

    The surgical procedure that you are to be admitted for depends on your specific requirements, but this information is for those who are to have surgery performed in the cervical spine (neck area). 

  • Related Service:

Related content