Minimally Invasive Posterior Discectomy/Decompression
Why is this surgery done?
A minimally invasive posterior cervical discectomy is usually performed because of nerve root compression from a cervical disc protrusion, or for an arthritic spur. These are painful problems with no loss of neurologic function for some. Yet for others, the arthritis or nerve root compression is severe and may cause neck and arm pain or weak and numb hands. If this applies to you, this surgery is usually recommended to prevent further loss of function. This surgery is an alternative to an anterior cervical discectomy and fusion.
How is minimally invasive posterior discectomy/decompression done?
During surgery, a small incision will be made on the back of your neck. Your surgeon will remove bone and ligament to get access to the spinal canal. Using a microscope, the nerve will be identified and the pressure will be taken off by removing disc material. During this surgery no fusion will be performed. Surgery typically takes 1 – 2 hours, and you are likely to go home the same day.
What are my risks? What are common complications?
This is a common surgery with high satisfaction ratings. It is effective in relieving arm pain and improving weakness. Numbness or sensory complaints take the longest to improve. However, there is no guarantee that your arm or neck pain will be relieved following surgery. You may experience some improvement of your symptoms, but you may have permanent damage that surgery cannot correct. There is a chance you will need more surgery due to new or recurrent symptoms.
While complications from surgery are uncommon, some can be serious and may include:
- Heart or lung problems from general anesthesia, which could be fatal
- Bleeding, which could require a transfusion
- Infection of the cervical incision, which could require IV antibiotics and another operation
- Damage to the covering of the nerve (the dura), which causes a spinal fluid leak and could require a drainage procedure or another operation. Although rare, this damage could result in paralysis, pain or bowel and bladder dysfunction.
- Deep vein thrombosis (DVT)
What do I need to know before surgery?
If you take any blood thinners—for example Coumadin, aspirin, Plavix, Xeralto, Eliquis or Ticlid—make sure your surgeon is aware of this medication as soon as possible. You will be given specific instructions regarding any need to stop or change your current use of any blood-thinning medication. If necessary, your surgeon will get clearance from your cardiologist or other physician to ensure that this medication change is safe and appropriate for you based on your heart history, including prior heart attack, stent placement or open-heart surgery.
Stop taking aspirin-based products one week before surgery. Also, stop taking nonsteroidal anti-inflammatory drugs such as ibuprofen, Naprosyn, Naproxen, Advil and Motrin at least one week before surgery.
Please do not eat or drink anything after midnight the day of your surgery. This includes water, coffee, chewing gum and hard candies. You may brush your teeth with toothpaste the morning of surgery.
Some daily medications may be taken the day of surgery with a sip of water. Medications that are appropriate to take the morning of surgery will be discussed with you by the hospital staff or your surgeon’s nurse.
General discharge instructions
After you return home and are walking around you may remove the support hose worn on your legs.
You can expect significant incision pain during the first several days after surgery. Typically, any leg pain will improve first. You may also experience numbness and tingling because of nerve damage caused by nerve compression. This will typically get better after a few weeks or months as the nerve heals. Please note, nerve damage does not always resolve after surgery.
Neck and back discomfort and stiffness are common after surgery. To help you manage the pain, you will be given a prescription for pain medication when you leave the hospital or surgery center. As the pain improves, you may change to Tylenol or Advil to help with pain control. An ice pack along the incision line will also help with any discomfort you feel.
You will leave the hospital with a waterproof dressing on your incision site. This dressing should remain in place for two days after you return home. Under the dressing will be Steri-Strips, which are small adhesive strips across the surgical incision. Leave these Steri-Strips on the incision and allow them to fall off naturally- this usually occurs within two weeks. If after two weeks the Steri-Strips have not fallen off, you should remove them.
After removing the dressing, your incision can be open to the air. It is important for a family member to examine your incision each day for one week after surgery to monitor it for any changes as the healing process continues.
If staples or sutures were used to close your incision, they will need to be removed 10 – 14 days after your surgery. Please call your surgeon’s office at (317) 396-1300 to schedule an appointment for this removal.
Some surgeons may use surgical skin glue that does not require any incisional care.
You may shower any time after surgery, but pay attention to your body and don’t shower if you are feeling lightheaded or tired. Simply pat your incision dry after your shower and leave the incision open to the air under your clothing.
Do not take tub baths or Jacuzzi baths and do not go swimming for the first three weeks after your surgery.
General anesthesia, inactivity after surgery and pain-relieving prescription narcotics may cause constipation after surgery. It may be helpful to take a stool softener and/or laxative after surgery. These medications, which include Colace, Miralax and Senokot, may be purchased over the counter at your local pharmacy.
What should I expect while recovering?
After your surgery, you will be in the recovery room for at least 30 minutes to one hour. When you first wake up from the anesthesia, your throat may feel sore, and you will likely feel cold, thirsty and groggy. Intravenous (IV) lines will be connected to supply your body with fluids.
After time in the recovery room, you will be transferred to the outpatient recovery area. Your family can return to spend time with you.
You will most likely be discharged to return home 1 – 2 hours after your surgery. However, if you have a more complicated medical history, you may require an overnight or longer hospital stay.
Possible physical therapy exercises
After leaving the hospital, physical therapy is usually not necessary for most patients. Your best therapy is walking, which increases blood flow to the spine and assists in the healing process. Try walking on a structured basis beginning slowly at first and progressing on a regular basis as your pain begins to lessen.
If your recovery is slower, you may need additional therapy after surgery. If needed, physical therapy will be discussed with you at your follow-up appointment.