Spinal neurosurgery refers to operations that are performed on the bones, discs and soft tissues of the spine with the aim of relieving pressure on the spinal cord or spinal nerve roots or the extraction of masses within the spine.
The most common cause for spinal neurosurgery being considered is pressure on the lower spinal nerve roots in the lumbar spine or upper spinal nerve roots in the cervical spine. This often occurs in the area termed the foramen which is the space which holds the nerves as they leave the spine.
This is often as a result of a combination of an intervertebral disc prolapse and thickening of the adjacent facet joints and ligaments that surround the spine.
Sometimes the problem occurs in the space termed the central canal which is often referred to as spinal stenosis. This is normally a result of individuals having a congenital (genetic) narrowing of the spinal canal which they would not be aware of until developing symptoms. This may get to a critical threshold when combined with thickening osteophytes (bone spurs) and thickening of the discs and soft tissue as a normal consequence of ageing.
There are other more rarely seen causes of central canal stenosis. One may be ossification of the posterior longitudinal ligament, a compression called OPLL, and in those cases, quite often the patients have to be given a wider bony decompression at the front of spinal cord.
Unfortunately, another reason for spinal neurosurgery being undertaken is to resect masses from around the spinal cord or within the dura (the sheath which houses the spinal cord) itself. These masses may be non-malignant but as they have the ability to compress the spinal cord they too often need to be dealt with by spinal neurosurgery.
Spinal neurosurgery is carried out in hospital under general anaesthetic. You will normally be admitted the evening before the operation. This allows you time to settle in and be prepared. You will not be able to eat for eight hours prior to surgery although you will be able to drink small amounts of water up to four hours before.
Depending on the exact surgery planned, the underlying problem as well as general health status of the patient your spinal surgeon will plan the most safe and effective approach to take. Some spinal neurosurgery is performed from an anterior (front) approach with the patient on their back and some performed from a posterior (back) approach with the patient lying on their front.
To achieve a decompressive operation on the cervical spine or lumbar spine the surgeon will firstly use xrays to identify the levels of the spine to work on. The skin will then be marked and the incisions made. The surgeon will carefully identify relevant muscles and organs to be pushed aside manually to avoid any damage to these tissues.
A tube known as a dilator will then be inserted over the relevant spinal levels and a retractor tool will be used to split the muscles and allow the surgeon to more easily visualise and work on the spine. Once easily visualised, the surgeon will carefully decompress the spinal cord or nerve roots using specialised tools to remove the disc material, osteophytes (bone spurs) or thickened ligaments.
If a large decompression is needed at more than one level of the spine then the surgeon may have to stabilise the relevant levels with a spinal fusion. To achieve a fusion following a standard cervical or lumbar decompression, the relevant discs will normally be replaced with a combination of a bone graft and a metal fusion cage.
Sometimes, instrumentation known as pedicle screws will also be inserted depending on the underlying cause for the instability and pain. If a fusion is needed due to very large scale decompression then it may be that rods are used to supplement the spinal fusion.
The risks of spinal neurosurgery will vary according to the exact surgery planned and your individual problem and general health status. These will be discussed in detail with you by your surgeon prior to your operation. Some general complications of cervical spine surgery which affect a very small percentage of patients can include:
- Infection can occur although our theatres have ultra-clean air operating conditions keeping infection rates to the minimum.
- Blood clots are possible after any operation and are more common in patients with some pre-existing medical conditions. However, again they affect a very small percentage of patients and have well established treatments including aspirin.
- Significant blood loss during surgery
- In rare circumstances patients, may suffer a stroke as a result of a blood clot developing
- Damage to the nerves in the cervical spine or lumbar spine which may result in sensory loss and weakness in the arms and/or legs and in extreme circumstances loss of bladder/bowel/sexual function.
- Masses may return following their removal
If a spinal fusion is used then some extra risks may apply. These will be discussed in detail with you by your surgeon prior to your operation and can include:
- Failure to fuse at the operated level
- Persistent pain at the site of the bone graft (normally the iliac bone at the pelvis)
- Progression of spinal disease especially at the adjacent spinal joints which may have increased loads and movement placed on them due to the fusion
Following your operation, nurses, doctors and physiotherapists on the ward will monitor your function and help you to get back to independence as quickly as possible.
Recovery from spinal neurosurgery is very dependent on the indication for the surgery and the exact operation which was undertaken.
Decompressive surgeries for patients who were displaying signs of spinal cord compression is not generally an operation that's done to improve people's function. Instead, it's done to prevent them becoming paralyzed or suffering quite marked neurological deterioration as they get older.
Decompressive surgeries for nerve roots rather than the spinal cord itself are normally done to relieve significant arm pain and the recovery from these types of surgery are often excellent as the patient can feel immediate pain relief.
If a spinal fusion has to be performed in conjunction with the decompression, in general, patients may be instructed for the first 6 to 12 weeks after the operation to return to a sensible, independent standard of living at home ensuring that they do not push their activities too much too early.
Walking around the house and up to two miles per day outside are sensible activities. Patients may also be instructed to ensure not to stay in one position for too long i.e. prolonged sitting or standing may increase pain levels during the initial period of time following a spinal fusion. Any weight lifted during the initial 6-12 weeks should weigh no more than a kettle.
Following discharge after spinal neurosurgery, our expert spinal physiotherapy team will continue to monitor your progress in an outpatient clinic and where necessary advise you regarding appropriate strategies to:
- Reduce pain following spinal surgery
- Reduce spinal stiffness following neurosurgery
Once your pain levels have reduced sufficiently our expert physiotherapists will work closely with you to:
- Increase strength in your spine
- Increase balance and co-ordination
- Where necessary prepare you for a return to sports & other higher level activities.