A posterior cervical decompression is an operation to relieve pressure on a nerve or spinal cord in the neck via a scar on the back of the neck.
Why is a posterior cervical decompression recommended?
The operation is performed to relieve pressure on a nerve that is causing arm pain or pressure on the spinal cord that is causing problems with hand function and walking.
Surgery is normally recommended after failed non-operative treatment. Non-operative treatment will include pain relief, physiotherapy and sometimes an cervical epidural injection of steroid. In cases of severe spinal cord compression, early surgery is likely to be recommended.
How is surgery performed?
Under general anaesthetic, a small incision is made in the back of the neck. The spinal muscles are retracted and spine exposed.
Once your surgeon has ascertained the correct spinal level with an x-ray, bone and ligament is removed resulting in decompression of the affected nerve root and/or spinal cord.
A thorough check is made that the nerves and spinal cord are free from compression. The wound is closed in layers, sometimes with a wound drain.
The operation usually lasts 1-2 hours.
What happens after surgery?
Post-operatively, you will be able to mobilise a few hours following surgery. A wound drain, if present, is removed by nursing staff the following morning and you will be reviewed by your physiotherapist. It is recommended that you do not drive a car for two weeks and that you do not work full-time for four to six weeks. The most important message following a posterior cervical decompression is to avoid lifting any significant weights for the first few weeks following surgery. It is normally recommended that you have 4-6 weeks off work after cervical disc surgery.
If you have any questions about your post-operative care, then your surgeon will be happy to speak to you directly.
How successful is the operation?
Patient satisfaction rates are 85-90% and we would expect 90% of patients to experience significant relief of arm pain. Pain relief is normally immediate. If numbness or weakness are present before the operation, then these may recover over a time period of months.
In cases of spinal cord compression, the aim is to stabilise neurological function rather than to reverse neurological disability that is already present. This is because the spinal cord has limited capacity for recovery after injury. Around 60-65% of patents see their symptoms stabilise and about 30% see some improvement in spinal cord symptoms.
What are the risks of surgery?
There is a small risk of wound infection (5%), bleeding (1%) or spinal fluid leak (2-3%).
Neurological injury to a spinal nerve or spinal cord is rare, but can result in serious problems such as numbness, weakness or paralysis in the limbs or problems with bladder, bowel or sexual dysfunction.
If your risk of worsening of spinal cord function is felt to be higher than normal (for example, if you have severe spinal cord compression) then your surgeon may discuss with you the use of intra-operative spinal cord monitoring.
There is a small risk associated with general anaesthesia (heart problems, chest complications, blood clots, infection) and these risks may increase with certain medical conditions.