Cervical Spine Surgery
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?
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.
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.
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:-
- Pain, most often in the arms or hands, but can be in the legs.
- Weakness in some or all of the limbs.
- Possibly some tingling or unusual sensations
- Stiffness in the limbs, especially the legs causing problems with walking.
- 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 or a cage 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:-
- 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.
- Managing your symptoms, this can include physiotherapy and medication for the management of your symptoms for example, pain and muscle spasms.
- In some cases osteopathic treatment or injection therapies may help.
- 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.
- Risk from anaesthesia (being put asleep for your surgery)
- Small risk of persistent or increased pain.
- Risk of injury to the nerves 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.
- Leak of spinal fluid.
- 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).
- Bleeding or haematoma (collection of blood)
- In patients having a graft, cage or any type of implant (rods, screws etc.) there is the potential for any of these to fail and/or move out of the correct position.
As already mentioned, complications are rare. If you are worried about any of the aspects of surgery, you will have the opportunity to discuss any concerns prior to surgery, following your Hospital admission.
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.
- 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)
- Vocal cord problems e.g. hoarse voice (this should settle down within a few days of surgery)
- In theory there could be injury to the nerve for sweating, eye lid and the pupil (Horner’s syndrome), although this is exceptionally rare.
You will be brought into Hospital for your pre-operative assessment.
Pre-operative assessment is important for us to make sure that you are safe to undergo your surgery and that we have everything in place for your specific needs.
This assessment will include:-
- 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.
- 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. Sometimes you not see the Anaesthetist until you come into Hospital.
- You will have some blood tests performed.
- If any x-rays or a heart trace (ECG) are required these will also be done.
- Your drugs 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.
All of this may be done at the pre-operative assessment clinic; an appointment will be organised for you and sent to you if you are required to attend for this. Please be aware that pre-operative appointments can require you to be at The Walton Centre for a few hours.
Some patient may not be asked to attend pre-operative assessment clinic, this can be for many reasons, for example, you are admitted quickly and there is no time to allocate you a clinic appointment. 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 in some cases up to 6am on the morning of your surgery. This varies depending on what time you are due to go for your surgery and the pre-op Nurse will clarify this for you. Most patients will be admitted the day of their surgery, fasting. This will be discussed with you at the pre-operative assessment clinic and all instructions will be explained to you. It is advisable not to bring any valuables with you into Hospital as the Hospital does not accept any responsibility for their safety.
The day of surgery
You will be kept fasted (nothing to eat or drink) and need to wear a theatre gown following your admission. 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 you details again; whilst this can appear repetitive it is all done to ensure your safety. You will be taken to the Anaesthetic room. Here the Anaesthetist will give you your anaesthetic medication and once you are asleep you will be taken into theatre and surgery will be performed. 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. I 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.
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.
Medication can be organised for you to take home if it is not possible for you to arrange them with your GP. Unfortunately, if we arrange medication from our pharmacy then this can mean you need to wait until late on your discharge day for it to arrive.
Your stitches 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.
Research has shown that patients who return to a 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.
It is usual for patients not to need additional physiotherapy input after they are discharged. The exercises are given to you for you to perform in order to help yourself with your treatment and recovery. For further information please see the physiotherapy section below.
If you need transport home it is advisable to let the staff know when you are admitted so this can be arranged in advance.
You will be sent an outpatient appointment for approximately 3 months by post, to come and see us so we can check you are recovering well. If you have any questions at any time please feel free to phone us.
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 made 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 months until you reach your full recovery potential.
It is not unusual for you to get increased pain, altered sensation, or changes in the strength and coordination of your limbs for a few days, weeks and even months after surgery. This is your spinal cord and/or nerves recovering from, not only your surgery, but from the months or in some cases years of abnormal pressure on them.
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 undertake the usual activities of daily life as you feel able, for example, washing, cooking, and shopping. Many people worry about re-commencing sexual activity, you can re-commence this whenever you feel comfortable to do so.
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.
You will be able to drive your car as soon as you can safely operate it; this includes you having a full range of vision and being able to made an emergency stop.
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. If you have concerns about this please discuss it with before your discharge or telephone us on the numbers provided on page 24.
As we have already mentioned, take your time and pace yourself, allow your body the time it need to recover.
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.
Physiotherapy following cervical spine surgery
This information has been designed for post-operative neck care. It is intended to answer the most commonly asked questions. Any further enquiries should be directed to your Physiotherapist.
The Physiotherapist may visit you during the day after your operation. The movement and strength of your limbs will be assessed so that an exercise programme can be devised for you. You will be shown the most appropriate exercises to be started immediately and progressed as directed. You will be expected, on your first day post-op, to be up and walking around.
General advice on posture
Good posture is important as it minimises strain on the joints and ligaments in the spine and therefore will reduce the recurrence of neck and back pain.
When you have a poor posture, the body’s proper vertical position is out of alignment and the back’s natural curves become distorted. Try to avoid:
- Head forward and slouched shoulders
- Slumped sitting positions
- Use a firm mattress (not hard) which allows absorption of your hip and shoulder.
- Lie horizontally in any position you find comfortable. Support your head with a pillow to make your head level with your spine.
- A firm upright chair should be chosen that allows your bottom right to the back whilst feet are flat on the floor.
- To correct your posture, tuck in your chin as if making a double chin.
You must avoid heavy lifting immediately following your surgery. You may resume lifting when you feel able to do so. When you do resume lifting ensure you use the correct technique. Ask your Physiotherapist to demonstrate if you are unsure of this. Use this method even if picking up light objects.
- Stand close to the object you are lifting.
- Face in the direction you will be moving the object – never list and twist.
- Bend the knees, keep the back straight, standing up by straightening the hips and knees. Initially your legs may be weak but will strengthen with practice.
- Never twist or rotate when you are lifting
- When shopping/travelling use two lighter bags rather than one heavy one – better still use a trolley
You can return to work as soon as you feel you can cope, even if your neck is still uncomfortable. Hurt does not mean harm. Returning to work and normal activities will help your recovery. Simple changes can make your job easier, talk to your foreman, boss or occupational health advisor.
The surgery may leave you with a painful and stiff neck. The exercises shown below are important to increase the mobility of the neck and strengthen the muscles which support it. They will also promote proper healing and ensure the joints of the neck are receiving the nutrition they require. Aim to keep your neck moving as normally as possible, as soon as possible. The longer you hold your neck in a rigid position the more painful it can be to get it moving. Start the exercises from day one in the Hospital; try to do 10 repetitions, 1 to 2 times each day.
Regular exercise has many benefits and the body must stay active to stay healthy. Regular exercise gives you stronger bones, develops fit and active muscles, keeps you supple and fit, makes you feel good and releases natural chemicals that reduce pain. Staying active will help you get better faster and prevent more neck problems.
The following exercises are taken from Physio Tools General Exercises. Use with permission from Physio Tools Ltd.
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:-
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.
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. It requires the person having the scan to lie still in the scan tube for approximately 30 minutes.
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.
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).
This is a forward slip of one of the bones of the spinal column on another which can mean the bones have step in the column. This can occur due to degenerative changes or trauma. It can cause narrowing of the canal in which the spinal cord runs and as a result can put pressure on the spinal cord or nerves.
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.
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.
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 September 2018
- Review Date:01 September 2022
- Author:Keren Smallwood
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).