Cervicothoracic Deformity Correction
Why is this surgery done?
Cervicothoracic deformity correction surgery is usually performed to help people with abnormal alignment of their neck and upper back. Many times, a patient is unable to lift their head up due to the abnormal alignment. This can lead to problems with breathing and eating. Some of the underlying issues of the spine that can lead to this problem include joint degeneration, tumors and infection of the spine or prior spinal surgery. Many times, the nerves within the spine (spinal cord) are being compressed from the deformity. This can cause, pain, numbness and weakness of the arms and legs. The surgery is performed to alleviate the compression of the nerves and allow them to heal.
How is cervicothoracic deformity correction done?
Cervicothoracic deformity correction surgery is usually a large surgery that can entail incisions in both the front and back of the neck and upper back. This type of surgery is done in a larger hospital with a team of physicians, including your neurosurgeon, anesthesiologist, surgical assistants and a nerve monitoring technician. The nerve monitoring is important to ensure your spinal cord is not injured during the surgery. During the procedure, your neurosurgeon will relieve any pressure on your spinal cord or any nerves that may be compressed. Bone screws are placed in multiple vertebrae (the bones of the spine) using sophisticated computer navigation techniques to ensure safe placement. These screws are connected to a rod. The rod is used to “pull” your spine into a more normal alignment. The number of screws and spinal levels depends on the location and severity of the spinal deformity.
In order to aid in the correction of spinal deformity, the surgery may require an osteotomy. This is a strategic cut in the vertebra used to loosen your spine and aid in realignment. Additionally, your surgeon may remove some of the intervertebral disc. These may be followed by placement of a cage, implant or graft to help with the correction of the deformity.
After the correction of the deformity, your surgeon will need to take measures to make sure your spinal bones fuse, or grow together. A successful outcome is greatly dependent on the fusion. Your surgeon may use a combination of your own bone, cadaver bone, bone matrix, stem cells and bone morphogenetic protein (BMP) to help your spine fuse.
The incision is then closed with sutures or staples. Sometimes after cervicothoracic spinal deformity surgery, a patient may stay intubated (breathing tube helping your lungs) and need to stay in the intensive care unit. This depends on the approach needed to correct the deformity, your general health before surgery and the length of the surgery, as well as many factors in surgery.
What are my risks? What are common complications?
This type of surgery is very complicated and entails significant risk. The risks of complications are directly related to the length of surgery, the complexity of the procedure and the lengthy recovery period. Patients with other medical issues are at an increased risk for complications.
This is not a comprehensive list, but some complications associated with cervicothoracic deformity surgery include:
- Infection, sometimes leading to additional surgery, increased pain or injury
- Blood loss, sometimes requiring blood products
- Damage to the spinal cord or spinal nerves, which can be temporary or permanent, and can result in pain, numbness, weakness or paralysis
- Damage to the covering of the spinal cord or a spinal nerve, which can cause a spinal fluid leak and may require a drainage procedure or another operation
- Failure of your bone to fuse, which can lead to additional surgery, increased pain or injury
- Acceleration of the normal aging changes in the bones adjacent to the fusion
- Problems with the bone screws or rods, which can lead to additional surgery, increased pain or injury
- Blood clots
What do I need to know before surgery?
Before your surgery, preoperative testing will need to be completed. To ensure medical clearance for surgery, testing such as blood work and EKG are completed. Usually, the surgical facility will contact you and will schedule an appointment for a detailed evaluation and examination. Additional clearance may be needed from a cardiologist, pulmonologist or another specialized physician.
This important checklist will help to ensure that you are prepared and ready for your surgery. Please read it and ask your surgeon to answer any questions you have.
- If you take any blood thinners—for example, Coumadin (warfarin), aspirin, Plavix, Xeralto, Eliquis, Brilinta 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 discontinue or modify your current use of any blood-thinning medication. If necessary, your surgeon will get clearance from your cardiologist or other physician to ensure 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 staff.
General discharge instructions
Often after an operation to correct a cervicothoracic deformity, patients are discharged from the hospital to an inpatient rehabilitation facility or a skilled nursing facility for continued recovery and care. Whether you leave the hospital for another facility or are discharged home, it is important to follow these instructions.
- Your incision can be open to air when you leave the hospital. It is important that your incision is examined each day to look for problems.
- It is important to keep the incision clean and dry. You may shower when you are home, but we do not recommend tub bathing, hot tubs or swimming until seen back by your surgical team.
- Sutures or staples are usually removed two weeks after surgery, but this can vary. Your surgical team will help coordinate removal of staples or sutures.
- 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.
- After leaving the hospital, physical therapy is recommended for some patients, even those who do not need a rehabilitation stay. Your surgeon may recommend physical therapy at one of your early postoperative appointments, depending on your progress. The most important part of your recovery 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.
- Do not drive for at least the first four weeks after surgery. We recommend you drive only when you are no longer taking pain medications and when you can comfortably turn your body far enough to drive safely using the car’s mirrors.
- Do not lift anything heavier than 10 pounds until you see your surgeon at the follow-up appointment 4 – 6 weeks after your surgery.
- Do not do things that require repetitive bending, twisting or lifting. Such activities include laundry, sweeping, vacuuming, shoveling and yard work. When you are moving, remember to use good body mechanics, which include using your legs instead of your back while lifting.
- Do not smoke. It is not healthy for your back or your body’s healing abilities.
- Please avoid nonsteroidal anti-inflammatory drugs such as Celebrex, Motrin, ibuprofen, Advil and Aleve. These medications may hinder the bone growth needed for the fusion occurring after your surgery.
Call your surgeon if you experience any of these symptoms:
- Signs or symptoms of infection, including redness, wound drainage, worsening pain or a fever of more than 101°F
- New or worsening leg weakness, pain, numbness or tingling as compared to before surgery
- Difficulty with bowel or bladder function
- Calf or leg swelling, tenderness or redness
What should I expect while recovering?
The recovery process from cervicothoracic deformity surgery is lengthy, often 9 – 12 months in duration. It is important that you follow the recommendations and restrictions of your surgical team to ensure a good outcome.
Managing your surgical pain can be difficult. Pain from surgery will change in intensity as you heal. This is normal and expected. Your back pain should slowly improve as the healing process occurs and your fusion becomes more solid. This healing may take several months. During this time, your surgeon will work with your primary care physician or other pain management specialist on pain management techniques and regimens.
Possible physical therapy exercises
After leaving the hospital, physical therapy is recommended for some patients, even those who do not need a rehabilitation stay. Your neurosurgeon may recommend physical therapy at one of your early postoperative appointments, depending on your progress. The most important part of your recovery 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. If your neurosurgeon has instructed you to use assistive devices (collar, back brace, walker or cane), please use them as instructed.