Cervical Spine Surgery: Key Considerations for Recovery

Q: Cervical Spine Surgery: Key Considerations for Recovery

Hello： A. <br>The principles of surgical treatment for cervical spinal cord injury are 1. <br>Decompression 2. <br>Reconstruction. <br>You have already undergone posterior decompression (without fixation), but if your symptoms have not improved and follow-up MRI shows significant

Cervical spine spinal cord injury, laminectomy decompression surgery, discectomy, mobile artificial intervertebral disc?

The mother is 62 years old and has diabetes, but it is uncertain whether she has osteoporosis.
She fell off her bike on the road and was urgently taken to the hospital due to weakness in her limbs.
The attending physician explained that she has cervical stenosis from C3 to C7, causing nerve compression and edema.
The recommended surgeries are: 1) A laminectomy from C3 to C7 for decompression, with the surgical incision at the back of the neck (this surgery has been completed; she can barely use her phone and can stand but needs assistance).
2) Discectomy, with four carbon fiber intervertebral discs (insurance approval obtained) and self-paid bone graft (scheduled to be performed in two weeks).
After researching, I mainly want to ask the physician the following questions regarding the second surgery: 1) If a laminectomy has already been performed, is a discectomy necessary? 2) If a discectomy is not necessary, can aggressive rehabilitation suffice? 3) If a discectomy is necessary, is the current treatment approach by the attending physician spinal fusion? The use of a movable artificial disc has not been mentioned.
Is a movable disc unsuitable for this case? (Self-paying is not an issue, but the doctor may not have brought it up, possibly fearing financial pressure.) 4) If a discectomy is necessary and a movable disc is also applicable, does multi-level fusion from C3 to C7 increase the risk of stress degeneration in adjacent segments? Would it be advisable to use movable discs for all four levels, or should there be a combination of fusion and artificial discs? 5) If a discectomy is necessary and a movable disc is not suitable, is multi-level fusion from C3 to C7 recommended? Would this be better than not doing anything? Will there be significant impacts on daily life, such as inability to look down or turn the head? Is there a high likelihood of needing another surgery in a few years?
The attending physician has scheduled the surgery for two weeks from now, with no opportunity for a follow-up consultation to ask questions, as the physician is busy.
I feel uncertain about the surgery and want to understand everything clearly before proceeding, which is why I am seeking a second opinion.
I apologize for the inconvenience.

MRI images after the car accident: https://imgur.com/a/iuPypQ6
Diagnosis: Incomplete spinal cord injury from the third to the seventh cervical vertebrae, accompanied by quadriparesis.

Medical advice: On October 20, 2022, undergo laminectomy from C3 to C7, discharged on November 1, 2022, required to wear a neck brace, needs personal care during hospitalization and after discharge, recommended to rest for six months and continue outpatient follow-up treatment.

Mr. Wang, 30~39 year old female. Ask Date: 2022/11/03

Dr. Lai Zhaokang reply Neurosurgery

Hello: A.
The principles of surgical treatment for cervical spinal cord injury are 1.
Decompression 2.
Reconstruction.
You have already undergone posterior decompression (without fixation), but if your symptoms have not improved and follow-up MRI shows significant anterior compression, and if the health insurance review is approved, you may consider additional anterior decompression and reconstruction surgery.
B.
Since posterior decompression has been performed (without fixation), anterior decompression must include the implantation of fixation devices.
Otherwise, both anterior and posterior structures will be unstable.
At this point, it is not suitable to use a mobile artificial disc for the anterior approach.
C.
Regarding whether all four intervertebral discs should be replaced with fusion cages during the anterior surgery, perhaps only the key segments should be selected.
You should discuss this with your surgeon.
D.
Multilevel fusion from C3 to C7 will indeed affect the degeneration of adjacent segments.
E.
After surgery, you can lower your head and turn it once fusion has occurred and the cervical collar is removed.
However, the range of motion will be limited.
F.
If you have concerns and decide to consult the original surgeon for surgery, you should actively ask the physician (to see if they have assistants or other contact methods).
Best wishes to you from Dr.
Lai Chao-Kang, Chief of Spine Surgery at Changhua Hospital.

Reply Date: 2022/11/03

More Info

When considering cervical spine surgery, particularly for a 62-year-old patient with diabetes and a history of trauma leading to cervical stenosis and neurological symptoms, several key factors must be taken into account regarding recovery and the necessity of subsequent procedures.

Understanding the Surgical Procedures
1. Decompression Surgery: The initial surgery performed (laminectomy) was aimed at relieving pressure on the spinal cord and nerves at levels C3 to C7. This is crucial in cases of cervical stenosis, where the narrowing of the spinal canal can lead to significant neurological deficits, including weakness and numbness in the limbs. The goal of this surgery is to alleviate these symptoms and prevent further neurological deterioration.

2. Disc Removal and Fusion: The upcoming procedure involves the removal of intervertebral discs and potentially spinal fusion. This is often necessary if there is instability following the decompression. The use of carbon fiber interbody spacers and bone grafts aims to promote fusion between the vertebrae, providing stability to the spine.

Key Considerations for Recovery
1. Necessity of Disc Removal: If the initial decompression surgery has adequately relieved the pressure and the patient is stable, the necessity of disc removal can be debated. However, if there is significant disc degeneration contributing to instability or ongoing symptoms, removal may be warranted. The decision should be based on the patient's clinical presentation and imaging findings.

2. Rehabilitation: Post-surgery, rehabilitation is critical. If the disc removal is deemed unnecessary, aggressive physical therapy may suffice to strengthen the surrounding musculature and improve function. However, if the surgery is necessary, rehabilitation will focus on regaining mobility and strength while ensuring that the fusion site heals properly.

3. Artificial Discs vs. Fusion: The choice between using artificial discs and performing a fusion is significant. Artificial discs can preserve motion at the operated levels, potentially reducing the risk of adjacent segment degeneration. However, they may not be suitable for all patients, particularly if there is significant instability or other complicating factors. The surgeon's experience and the specific characteristics of the patient's condition will guide this decision.

4. Impact on Daily Life: Post-operative restrictions are common, especially in the early recovery phase. Patients may experience limitations in neck mobility, which can affect daily activities such as driving, looking down, or turning the head. It is essential to set realistic expectations regarding recovery timelines and functional outcomes.

5. Long-term Considerations: There is a possibility of needing further surgery in the future, particularly if adjacent segments become symptomatic due to altered biomechanics following fusion. Regular follow-up and monitoring are crucial to address any emerging issues promptly.

Conclusion
In summary, the decision-making process regarding cervical spine surgery and subsequent interventions should be collaborative, involving the patient, their family, and the surgical team. It is essential to weigh the risks and benefits of each procedure, considering the patient's overall health, the severity of their symptoms, and their long-term functional goals. Given the complexity of the case, seeking a second opinion from a spine specialist may provide additional insights and reassurance before proceeding with surgery. Open communication with the surgical team is vital, and patients should feel empowered to ask questions and express concerns about their treatment plan.

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