CERVICAL MYELOPATHY

CERVICAL MYELOPATHY

Cervical myelopathy involves a spinal cord compression in the neck. Frequently this disease affects senior adults due to the degeneration of the spine by ageing in which bones, discs and / or ligaments end up exerting pressure on the spinal cord. This compression can hinder or block nerve stimuli between the brain and limbs, affecting both mobility and sensitivity of the limbs and torso.

The most frequent symptoms of cervical myelopathy are pain in the neck, shoulder and arms, tingling or numbness in arms and legs, difficulty when walking or keeping balance, muscle weakness and/or dizziness. It may even affect the ability to urinate or defecate in advanced cases.

When is the intervention indicated?

The initial treatment is with medication and rehabilitation treatment. However, when the symptoms of myelopathy are major or progressing, surgical treatment may be necessary.

What is the operation about?

It depends on each case and sometimes on the experience of each surgeon to choose a posterior or anterior technique. Anterior surgery is the most frequent and is performed through an operation through the folds of the skin to the right and anterior half of the neck. The goal of the operation is to remove the herniated disc or the osteophytes (part of the vertebra that protrudes and exerts pressure on the medulla). Frequently, after removing the disc, a biocompatible intervertebral box (anterior arthrodesis when you want to immobilize these vertebrae) is placed and sometimes a plate with screws is placed anterior to the vertebrae to ensure the immobility of that segment of the spine. The posterior surgery is done through a major incision in the midline of the neck, the back of one or more vertebrae is resected (laminectomy), so compression is removed from the nerves and the medulla. Placement of fixed prostheses may be necessary (screws and rods to hold the vertebrae).

What are the risks, complications and possible sequelae?

Often, temporary discomfort in the neck and pain when swallowing appear. These drawbacks subside within a few weeks and are easily controlled with treatment. More rarely, problems may occur with pieces that are placed between the vertebrae, infections from the wound or derived from the application of general anaesthesia. The most serious complications described above, albeit exceptional, are those of injured areas near the cervical spine (spinal cord, esophagus and trachea), and may range from greater or lesser nerve injury to be a cause of death (exceptionally).

Postoperative of Cervical Myelopathy

Generally, the patient is hospitalised in the Intensive Care Unit (ICU) for the first 24 hours after the surgery for stricter monitoring. After these first hours and except for the appearance of complications, the patient is hospitalised. After the first day, the patient can get up (if his previous state allows it) by wearing a cervical collar. Usually, rehabilitative treatment with physiotherapy is initiated during admission.

The discharge depends on the symptoms the patient had when admitted or whether it was an evolved myelopathy or not; however, generally, the discharge can be granted after 48-72 hours of the operation depending on the condition of each patient. In the discharge report, which patients receive before leaving, the intervention will be described and relative rest, wearing a cervical collar and the use of painkillers will be recommended.

What happens at the moment of hospital discharge?

When the Head Practitioner handling your case decides the discharge, you will receive a clinical report detailing the characteristics of your illness, the type of intervention performed and the treatment to be followed at home. Then you will be sent to the Neurosurgery Outpatients department to carry out an evolutionary follow-up of your case.

Advice after the intervention

The postoperative recovery period lasts four to six weeks after the intervention. During this time you should try to keep physical and mental rest, avoid trips and journeys, and take the measures listed below. Depending on the previous symptoms presented by the patient, the recovery period can be extended up to 6 months and even 1 year in cases with severe symptoms. Sometimes it is necessary to enter a rehabilitation centre to facilitate functional recovery.

FIRST TWO WEEKS

In case you are discharged to your home, you should not believe that this means everything is over. You must accept that you will continue the period of hospitalisation at home for a few days or weeks. Take the medication exactly as prescribed by your surgeon. If you are receiving any other treatment for any other disease, you should continue to do so unless you are told otherwise. Ask your surgeon regarding surgical wound care (they will depend on the type of suture used). You can shower, with assistance, trying not to touch the dressing of the wound unless told otherwise. Skin sutures should be removed seven days after surgery, although sometimes reabsorbable sutures that do not require stitches are used.

The cervical collar, which can be soft or rigid, must be worn at all times, unless your surgeon tells you otherwise. To sleep, it will be needed that you put it on, in order to prevent sudden involuntary movements. Try not to keep a fixed posture of your head during these two weeks – for instance, watching television for a long time or reading a book – to avoid muscle overload that can be painful.

It is recommended to progressively increase the pace of your normal routine till you reach the point of going out for walks. Do not travel by car or other means of transport during these two weeks (except to go to the health centre or visit the doctor).

THIRD AND FOURTH WEEK

By the third week you will feel pretty recovered. Neurological symptoms may persist, depending on the degree of spinal involvement; recovery is slow and it may take up to a year. Sometimes complete recovery is not possible. Keep in mind that complete healing requires between 4 and 6 weeks. Be patient. The wound must be completely healed and will not require any dressing but, if you wish, you may place a piece of gauze over the scar to avoid rubbing with your clothes. Start leaving home and walking increasingly long journeys, always on flat terrain and with sports shoes.

Keep the collar on whenever you get out of bed and go for a walk. It is mandatory that you use it if you are in a motor vehicle, although it would be better to avoid riding in a vehicle at all unless you go for a medical consultation. At the end of the fourth week you should go to the doctor’s office for a review.