Anterior and Posterior Decompressions with Fusions

Decompression is a procedure performed to relieve symptoms caused by pressure or compression on the spinal cord and nerve roots. The spinal cord is a cord of nervous tissue. It extends from the brain and passes through the spinal canal (passage formed by the openings in the backbone). Nerves branch out from the spinal cord to different parts of the body. Vertebrae (backbones) are a group of individual bones. They form the spinal column. Each vertebra is made up of lamina (bony arches of the spinal canal), spine, and foramen (opening in the backbone). A disc is a soft, gel-like cushion between each vertebra.

Decompression can be carried out as an anterior or posterior procedure. Anterior decompression is where the surgeon makes an incision more toward the front of your body in order to get access to the area needing repair. Posterior decompression is where the surgeon makes an incision more toward the back of your body in order to get access to the area needing repair. Depending upon the details of your specific condition, there are reasons why the surgeon may choose one approach over the other.

CAUSES

Compression of spinal cord and nerves can be caused by:

  • Bulging or collapse of the spinal disc.

  • Loosening of the ligaments.

  • Bony growth.

The causes of the spinal cord compression include:

  • Degenerative diseases (such as with many arthritis problems).

  • Rupture of the disc.

  • Traumatic injury.

  • Spinal stenosis (narrowing of the spinal canal).

  • Pott's disease (tuberculosis of the spine).

LET YOUR CAREGIVER KNOW ABOUT:

  • Bleeding and clotting problems.

  • Allergy to anesthesia medications.

  • Allergy to medications like steroid and blood thinners.

  • Previous surgeries.

  • Bone diseases like disease of low bone mass (osteoporosis) and infection of bone (osteomyelitis).

  • Cancerous (neoplastic) conditions.

RISKS AND COMPLICATIONS

  • Bleeding and collection of blood outside the blood vessels.

  • Damage to the blood vessels. This can cause heavy bleeding and even death.

  • Damage to the nerves. This can cause pain, loss of sensation, paralysis, and weakness.

  • Damage to the covering of the spinal cord (meninges). This can cause the cerebrospinal fluid to leak.

  • Complications involving graft and plate.

  • Inadequate fusion.

  • Wound infection.

BEFORE THE PROCEDURE

Your caregiver will make sure that you have been given a reasonable trial of nonsurgical treatment methods. Your caregiver may perform an X-ray study with a dye (diskogram). The injection of a dye into a disc may produce a pain similar to your back pain. This will help your caregiver to identify the disc, which is the source of pain.

PROCEDURE

Your surgeon will perform spinal decompression and fusion while you are under general anesthesia. There are different methods of performing decompression surgery. They include the following:

  • Diskectomy. Your surgeon will remove a portion of a spinal disc that is causing pressure on the nerve roots.

  • Laminotomy or laminectomy. Lamina refers to bony arches of the spinal canal. Laminotomy is a procedure in which your surgeon removes a small portion of lamina. Laminectomy is the removal of an entire lamina.

  • Foraminotomy or foraminectomy. Foramen refers to the opening in the backbone for nerve roots. Foraminotomy is the removal of a small amount of bone and tissue forming the foramen. Foraminectomy is the removal of a large amount of bone and tissue.

  • Osteophyte removal. Your surgeon removes bony growths called osteophytes. These cause pressure on the spinal column.

  • Corpectomy. Corpus refers to the body of vertebra. This procedure involves the removal of the body of a vertebra and also the discs.

  • Spinal fusion is required if there is a curvature of the spine or forward slip of a vertebra. Spinal fusion is a procedure of fusing two or more vertebrae together with a bone graft (new bone or substitute material from your body). This is further strengthened by using screws, plate, and cage apparatus.

  • Fusion prevents motion between 2 vertebrae. It also prevents the curvature of the spine and slip of vertebra from getting worse after surgery.

AFTER THE PROCEDURE

  • You will be moved to the recovery room and then to the hospital room.

  • You will have a thin tube (catheter) inserted into the urinary bladder to help in urination.

  • Your may have pain for the first few days after the surgery. Your caregiver will give you medications to control pain.

  • Your caregiver may order blood tests to monitor oxygen carrying protein of the red blood cells (hemoglobin). This would be due to blood loss during the surgery. Hemoglobin should be monitored to make sure that the level of blood oxygen does not become too low.

  • You will be given a back brace. A back brace limits motion and helps fusion of the bone.

  • You may continue to have mild pain even after full recovery.

  • You may have a series X-ray examinations over time. This will ensure adequate healing and appropriate alignment at the site of operation.

HOME CARE INSTRUCTIONS

  • To get strength and function, start physical therapy, occupational therapy, and exercises.

  • To ease the pain, you may have to exercise regularly. That also helps in weight loss.

  • To keep your spine in proper alignment, you should sit, stand, walk, turn in bed, and reposition yourself as instructed.

  • At first, take only short walks. Slowly increase other activities.

  • Avoid smoking. Nicotine inhibits fusion of the bone.

  • If narcotics (pain medication) are prescribed, you should not drink alcohol. You should not drive when you are on this medication because you will feel drowsy.

  • Avoid use of pain medication products and nonsteroidal anti-inflammatory agents (pain medication). They interfere with the development and growth of new bone cells.

  • Your caregiver may recommend using ice to manage pain. Ask your caregiver for instructions on how to do it.

  • Avoid lifting heavy objects.

  • Avoid bending and twisting motions.

SEEK MEDICAL CARE IF:

  • You have increased pain.

  • There is expanding redness at the operative site.

  • You have a fever.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have any discomfort with the substitute material that has been used during the spinal fusion procedure.

  • You feel a collection of blood outside the blood vessels.

  • You notice any changes in the smell, appearance, or amount of drainage.