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Cervical vertebrectomy

This procedure is designed to relieve arm pain and or numbness and weakness affecting the arms or the legs due to pressure on the spinal cord and or nerve roots. This operation is not designed to relieve neck pain.

 

Once you are anaesthetised, you are placed face up on the operating table. A horizontal, gently curved incision, approximately 3 cm long, is made just to the right of the Adam’s apple usually within an existing skin crease. We use an X-ray machine (Image Intensifier) to help us locate the correct position. Local anaesthetic is used to numb the nerves in this area and so lighten the anaesthetic needed. The muscles on the side of the neck are then parted and a path taken to the front of the spine. The correct level is then again confirmed with an X-ray. Special retractors are used to hold the soft tissues safely aside – these include the larynx (wind pipe), the oesophagus (swallowing tube), carotid artery and jugular vein. Another special distractor instrument is then used to hold the vertebral bones slightly apart so as to create space to work in. It spans the bones and discs to be operated on/removed. The operating microscope is then brought in and the surgeon operates thereafter looking through this – it brings superb illumination as well as magnification to allow precise operating. Everything up to this point is referred to as “access”. Now the operation proper begins.

The front part of the discs and bones are cleared.

Gradually, the back of the disc and any osteophytes are cleared and the central canal is exposed thus gradually relieving the pressure on the spinal cord. This surgical part of the procedure is termed central canal decompression and the operation has slowed to a snail’s pace at this point as the spinal cord is immediately below. A specifically designed high speed air drill is used in this instance.

The nerves exiting the spine on either side are now cleared of any disc prolapse or osteophytes. This element of the operation is termed nerve root decompression. The removal of the disc prolapse itself is termed a discectomy.

For patients that need a whole bone or bones and their associated discs removed so as to relieve pressure on the spinal cord and nerve roots over several levels, the operation is called a vertebrectomy/corpectomy.

Following a vertebrectomy/corpectomy, a fusion is always required.

We often need to harvest bone graft from the pelvic bone. This is done through a separate incision over the bony prominence of the pelvis near the front – usually on the right. A plate and cage are used to hold the spinal bones and any graft in place. This part of the procedure is called the reconstruction.



Next comes the final stage of the operation, called closure. Meticulous care is taken to stop any bleeding and the wound is then stitched in layers using internal absorbable stitches. A drain is often placed at the base of the wound. This is rather like a drip and is removed at around 24 hours. The skin is closed with a single stitch made of nylon. A dressing is applied. You will then usually need a collar fitted.

The suture is removed 5 days later by simply pulling on one end – do get an adult to help you!

Informed consent 

Before you have a procedure of any kind, however trivial you may feel it to be, you must be fully aware of the possible and likely consequences. You have to sign a consent form in which you state that you are fully aware. We will go over this with you in your consultation. Do not sign the consent form for a procedure with us unless you feel fully informed of its aims and risks, as well as the alternatives.

Please make sure you are fully content with everything set out in our Informed Consent for Treatments: Operations and Injections form.

What alternative procedures are there?

Much of this will have been discussed in our consultations. Essentially, an operation is always the last resort. Instead, you could try injections or further conservative treatment (physiotherapy, osteopathy, chiropractic, acupuncture, tablets and time). Obviously, we will usually have formed the view that these are unlikely to bring you to comfort any time soon before recommending surgery. For the majority, it is pain that drives the surgery. In these circumstances, you have to feel that the degree of pain warrants the risk and effort involved in putting yourself through the operation.

What are the Risks?

No procedure is without risk, though these are routine operations which rarely cause harm. Please click here for an extended list of risks involved with this operation.

When can I go home?

Most people go home on or around the third post-operative day.

Post-operative neck care

Before you go home after your operation, we will have discussed some details of how to care for your neck in the weeks that follow. Please click here for an extended summary.

*If you feel you are developing unexpected troublesome or worrying symptoms, do not hesitate to call The Spine Surgery London or the ward staff, who will be able to guide you.

When is my first follow up after surgery?

Our usual routine is to see patients three to four weeks after discharge and it is at this point that we can start the physiotherapy. Often there is a need for follow-up X-rays so it is useful to have the old ones for comparison, so please bring these with you. I usually then see you after another six weeks and then after a further three months.

When can I go back to work?

This may reasonably be anytime between four and twelve weeks post surgery.

Please click here if you would like to read more about when is best to go back to work.

What do I do in the event of problems?

If, once you get home problems arise, help is available from a number of sources. Firstly, if it is during working hours, you may ring The Spine Surgery London. If it is out of hours, our voicemail will tell you what to do in the event of an emergency.

Secondly, you may ring the hospital and ask to speak to our Spinal Nurse Specialist. In her absence, you should ask to speak to the hospital’s Duty Manager or to the ward staff (please go to Contact Us page for more information).

You may of course contact your general practitioner or any emergency service, should you so wish or if the other avenues fail.

We do not provide a 24 hour emergency service but can respond on most occasions.

For more concise pre-operative and post-operative information regarding cervical vertebrectomy, please press here for an information pack.