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Keyhole decompression

Posterior cervical decompression surgery/Keyhole decompression

This operation is to help relieve arm pain and or numbness and weakness affecting the arms which is caused by pressure on the spinal nerve roots which emerge from the spinal cord. Increased pressure can come from a cervical prolapsed disc or narrowing at the exit foramen which both can press on the emerging nerve root. This procedure is not designed to relieve neck pain and is especially for patients who have a lot of degeneration at the intervertebral/exit foramina, particulary if this is at multiple levels. As these are located more towards the back of the neck, your surgery is performed from the back, sometimes utilising a keyhole technique. Essentially, the more levels which need to be treated the larger the incision. A one or two level procedure is keyhole, whereas any more than that and the incision becomes substantial.

Please click here if you would like to read about how this surgery is performed.

At surgery, once you are anaesthetised, you are taken through into the operating theatre. You are placed face down on the operating table. The head is held in place with a special frame, so as to avoid pressure on the eyes and nose from being face down for a prolongued period. This will leave three pin sites in the scalp area which heal well but are sore in the first few days. An incision is made on the back of the neck. Where precisely this incision is made is determined using an X-ray machine (Image Intensifier). Local anaesthetic is injected to numb the area of skin where the incision is to be made and the tissues below. The length of the incision depends on number of levels requiring decompression. The muscles on the side of the neck are then parted and the spine’s front identified and exposed. The correct level is then again confirmed with an X-ray. Special retractors are brought in to hold the soft tissues safely aside. The spinal bones can then be seen. We then bring in the operating microscope allowing this procedure to be caried out safely. For a single nerve root, the gap between the lamina is exposed and widened to gain access to the spinal canal.

If there is any osteophyte and ligament thickening around the intervertebral foramen, these are removed taking the pressure off the cervial nerve roots. This is known as a nerve root decompression. If there is a prolapsed disc, this can sometimes be removed though more often this requires anterior surgery. If this is done it is known as a discectomy. For those of you having more than one level or side operated on, the procedure is now repeated at these other sites.

If the degeneration has caused narrowing of the central spinal canal there will be presure on the spinal cord itself. In this circumstance entire laminae and spinous processes have to be removed in an operation called laminectomy or central canal decompression.

The wound is then stitched in layers using internal absorbable stitches. A drain is sometimes placed at the base of the wound.The skin is closed with simple clips or sutures which are removed after 10 days often by our spinal nurse.

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 a general summary of risks for this type of surgery:

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 regarding post-operative care.

*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.

Follow up

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. We usually then see you after another six weeks and then after a further three months.

Return to work

This may reasonably be anytime between four and twelve weeks post surgery. If you would like to read more about when you should return to work, please press here.

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 Princess Grace 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 posterior cervical decompression surgery, please press here for an information pack.