Posterior Cervical Decompression and Fusion
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- Опубліковано 27 вер 2024
- In this video, we'll review one of the most common cervical spine surgeries -- the posterior cervical decompression and fusion, or PCDF for short.
Throughout the video, we'll provide insights into the anatomy and structure of the cervical spine as it relates to this procedure. We will also review what the PCDF involves specifically and use illustrations and animations so that you have a better understanding of how this procedure is performed and why it is one of the most powerful techniques we have for decompression of the spinal cord and nerves.
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DISCLAIMER
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The Video Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have viewed on this channel.
I had this surgery two years ago. I am a success story. My balance and bladder issues as well as the loss of dexterity in my hands were completely restored. I was blessed with a talented neurosurgeon.
Excellent! I am so happy to hear it. Good luck! -SP
Dr Prasad, I have watched a very high percentage of your videos. You are the best educator of human spine pathology and treatment options bar none. I have referred several people with spine problems to your youtube channel so they can better understand their disease and how a great surgeon like you could possibly help them overcome their spine problems.
Important question....I have not only now had 2 cervical fusions, but a thoracic plus a lumbar fusion as well. Dr Prasad, important question......will you ever produce some Lumbar spine videos ?? Obviously many people such as myself suffer from not only cervical spine problems, but lumbar spine problems as well. I would love for you to eventually produce some lumbar spine videos. Thank you !!
48 hours till i get my surgery at Kaiser. Thanks for the calm explanation. I have watched a lot of videos but this is one of the only ones that i have seen that i can forward to my mother and wife so they could have some understanding and peace of mind for what I am going to go through in a few days. More so for them then me thank you. I think your explanation will ease their anxiety.
I'm so happy to hear that! Thanks for sharing that and best of luck in surgery! Cheers, -SP
Thank you for going over the area of the spine that is exposed. I have been panicking over that part not being protected afterward!
My Pleasure! Thanks for watching, SP
Thanks so much….im getting ready for surgery and this certainly explains it so well. I have pathology on both sides n I was wondering how doing a posterior approach would help with the anterior compression on my spinal cord. You really helped explain that so well.
Doctor, I had this procedure about 2 weeks ago, and A) the laminectomy was at 3 levels C5,6,7, but they only put screws at 5 and 7, leaving 6 floating, and B) they mentioned that some of the removed bone was ground up and inserted as starter material for the eventual bone fusion. Do these techniques sound like stuff you’re familiar with? I don’t mistrust the surgeon or anything,I’m just curious how that lines up with current best practice.
Awesome video and explanation
Thanks Lena! Glad you found it helpful, -SP
Absolutely phenomenal presentation Dr Prasad. I have seen about 10 other Neurosurgeons here on youtube discuss PCDF, and you do, by far, the best job explaining it. My neurosurgeon here in Phoenix, will be performing a PCDF C4-C7 in about 14 days, followed by a L5-S1 discectomy and fusion to relieve bilateral severe L5 and S1 nerve root compression by that L5-S1 intervertebral disc (which is causing extremely weak dorsiflexion and plantar flexion of my ankles as well as weakness in my glutes and hamstrings) immediately after the cervical fusion. If the L5-S1 discectomy and fusion does not relieve the extreme weakness in my dorsiflexion and plantar flexion from my L5 and S1 nerve roots being compressed (I have not been able to stand on my tip toes since Mid May 2023 - very weak plantar flexion for almost 12 months - since mid May 2023), then I did some research on you, Dr Prasad, and I found that you are also a Fellowship trained Peripheral Nerve Surgeon !!! I think that is awesome that you are also a Peripheral Nerve Surgeon. Anyways, Dr Prasad, if after the L5 -S1 discectomy and fusion - and after the decompression of my L5 and S1 nerve roots bilaterally - my strength in plantar flexion does not return, then I think I am going to need your help in performing a Nerve Transfer Surgery to fix my plantar flexion weakness - a Nerve Transfer Surgery to reanimate my Soleus muscles and Gastrocnemius muscles to restore my plantar flexion since they are so weak that I cannot stand on my tip toes, it is difficult for me to walk uphill or climb stairs - the Gastrocnemius is a very important muscle for walking up a hill or climbing stairs- and it is impossible for me to jog or run as well ever since mid May 2023 since the plantar flexors are so extremely important for being able to jog / run. Also, when I walk, since my plantar flexors are so extremely weak, I have almost no "push off" from my Soleus and Gastrocnemius so walking is very very difficult and people have commented that ever since mid May 2023 it looks like I am having great difficulty walking.
I might be needing you for a nerve transfer surgery Dr Prasad. I'd fly to Philadelphia to have you do a Nerve transfer surgery to reanimate my Soleus and Gastrocnemius. For my Soleus.... I am thinking a dual transfer - perhaps Anterior Obturator Nerve to Soleus as well as Vastus Intermedius to Soleus. For my Gastrocnemius - I have looked on Pubmed and a popular dual nerve transfer that has seen very good results (restoration of MMT of 3 and MMT of 4) is Vastus Medialis to Medial Gastrocnemius and Vastus Lateralus to Lateral Gastrocnemius. Thank you Dr Prasad. I enjoy learning about Peripheral Nerve Surgery from Dr Susan Mackinnon of Washington Univerdity in St Louis, Missouri. Dr Susan Mackinnon is a pioneer of Peripheral Nerve Surgery, she basically invented nerve transfer surgeries !!! Anyways, I have probably spent about 40 hours watching Susan's youtube videos on Peripheral Nerve Surgery. It helps that I have a BS in Premedicine from a very good University, so I have a strong background in Medicine. It helps me study and understand Susan Mackinnon's videos. I love learning about Nerve transfer surgeries.
Hi Mr. Fox, thank you for the kind words and details. Good luck with your upcoming surgeries! Although I did historically perform a fair amount of peripheral nerve surgery I really have backed off since it is impossible to be at the forefront of everything. Innovation in peripheral nerve reinnervation has really taken off and there are a few centers that are at the forefront of this. Dr. Wilson Ray at Washington University is incredible and I would highly recommend that you see him if you aer willing to travel. There are other places I could recommend. Feel free to email me at srinivas.prasad@jefferson.edu and I can help guide you with your peripheral nerve journey if that becomes necessary. Good luck again! -SP
Hi Dr Prasad, thank you for the reply. I have read many wonderful things about Dr Wilson Zack Ray at Washington Univerdity in St Louis, MO. In fact, Dr Ray is head of the Peripheral Nerve Fellowship there at Washington University !! I read in your Bio, Dr Prasad, that you did your Neurosurgery residency at Washington University !! I bet you might know Dr Wilson Ray very very well !! The Neurosurgeon here in Phoenix who will be performing my Cervical fusion and Lumbar fusion actually did his Neurosurgery residency with Dr Ray at Washington University !! Perhaps you might have trained with my neurosurgeon at Washington University, Dr Prasad ??? It is very possible. I was watching other videos on youtube on nerve transfer surgeries and guess who several different peripheral nerve surgeons were absolutely raving about as a peripheral nerve surgeon ?? Dr Wilson Zack Ray !! Since you are no longer focusing on nerve transfer surgeries Dr Prasad, it sounds to me like I should drive to St Louis and have Dr May perform the reanimation of my Soleus and Gastrocnemius, if the L5-S1 lumbar decompression surgery does not restore strength to my plantar flexors.
Dr Prasad, if you don't mind me asking, how common is it in your experience for patients like me with severe L5 and S1 nerve root compression from severe lumbar foraminal stenosis to have lasting plantar flexion weakness so severe as to require a nerve transfer surgery to reanimate their plantar flexors ??
Thank you so much Dr Prasad !! I am determined to watch every one of your youtube videos at least 3 or 4 times. I have a BS in Biomedical Science, Magna Cum Laude 3.8 GPA. You have inspired me to return to the University and get my BS in Nursing !! I love medicine so much. I have a strong background in medicine, and I feel that by becoming a Nurse, I can use my medical knowledge to help patients tremendously.
Thank you so much for this channel !!! Steven
I also just realized that your youtube videos are only on the cervical spine. I hope some day you might also be able to do a series on the thoracic and Lumbar spine as well. I know it takes an enormous amount of time to produce these videos, Dr Prasad. But you are the very best of all the youtube spine surgeons at explaining a very complicated topic. Thanks again !!
Very informative thank you for the explanation...I had a failed fusion attempt in the front because of damage from cancer radiation and posterior fusion is my only option for relief from nerve pain and discomfort.
My pleasure. Good luck! -SP
I have a unique problem I already have a fusion with a plate in C-3 & C4 and now I herniated my C7 disc and now it will require surgery. How will they add another plate to my neck?
Watching from usa ❤❤❤❤
Awesome! Thanks for watching. Hope you found it helpful. Cheers, SP
@@prasadspineacademy wattsapp contact?
I'm having this surgery tomorrow morning. Thank you so much for going through every detail!!!! Set my mind at ease for the most part. They're also fusing c2-c4. Have had chronic pain for 2+ years now that has progressively gotten worse and this (hopefully) is the last stop along those lines. Since they're only fusing 3 levels, does anyone know how much ROM I will lose? As it is now I have a good ROM but it's rather painful if I turn/bend my head even just a little bit.
Good luck! I hope it helps! How much ROM you lose depends a little on how much ROM you have from C2 to C4. This is best evaluated on flex-ex Xrays so it is impossible to really say but in general you shouldn't lose a lot of range of motion. Cheers, -SP
I am just a week out from my posterior cervical laminectomy with instrumental fusion on C3 to T1. I looked up a lot of things on what it will be like once o got home. One thing they never told me about were the horrible muscle spasms in my neck, shoulders and upper back. That is the most horrible part of recovery to me.
Oh my gosh. That is very very common; it's almost an expected part of recovery but it definitely gets better. The first 3-4 days are the worst in my experience. I routinely use muscle relaxants in the post-op period in my patients; hopefully you have that as it will help. Good luck with the remainder of your recovery! -SP
I too am having this surgery and have spasms often already.
I’m from Malaysia. Just underwent the surgery c2-c6 on 12/3/2024 by Prof. Dr. Dharmendra. First 1 week was horrible due to muscle spasms. Now movement as usual after my physiotherapist did excellent job.
Is this procedure ever used for emergency repair, such as after a car crash or similar trauma? Or is this a planned procedure only, considered along with X-rays, MRI’s or ultrasound imaging?
Hi, yes it can is often used in the setting of spinal cord injury with or without fracture in the cervical spine. It is an effective technique especially for decompresing the spinal cord and stabilizing the spine, whatever the indication. Thanks for watching, -SP
Will this procedure decompress the nerve roots from a ventral pathology such as unconvetebral hypertrophy?
It doesn't usually allow direct decompression of ventral pathology except for soft disk herniations which can be fished out sometimes. This procedure allows for "indirect" decompression -- by unroofing the spinal cord and nerves it allows these structures to drift away from ventral pathology. Hope that helps! -SP
Hi there… I am going into cervical surgery for the 3rd time. I’ve had a spinal fusion failed surgery and I am having this surgery to repair. Is there any way to know how it will help? Thank you 🙏🏼
I'm afraid it is hard to predict. Success depends on the accurate identification of the symptom-generator and this is impossible without examining you and your imaging. Even with all of that it is often hard to predict how much relief patients will get. Sorry I can't help more! -SP
I am having a laminectomy on May 2nd because of a tumor between T2 and T3. The neurosurgeon tells me it is a schwannoma. He is going to perform a faciectomy also. My main concern is the recovery. Will I ever be able to pull my compond bow back again?
Good luck in your recovery! I can't comment specifically since I haven't seen your imaging and I am not sure what your surgeon is performing. I am sure that your surgeon can provide more accurate guidance. Warm regards, SP
Day 3 post surgery. I just go home from the hospital. I am in a lot of pain. Everyone is telling me it will get better every day. My nurse told me day three is the worst. I am praying she is right.
How long is the score? And is it very visible?
Correction. How long is the scar? And is it very visible.
The scar for this ends up being as long as the number of level being decompressed and fused. Usually 4-6 inches. Depends on the pathology and the particular patient's neck anatomy -- people with longer necks usually have longer incisions! Hope that helps, -SP
I had a posterior cervical decompression and fusion c4-c7. I had a huge bone spur behind c5. I had extreme burning in my left wrist n left bicep. 1 week after surgery I still have the same symptoms. What else could be causing these burning symptoms?
This will be my 3rd surgery to stop the same symptoms. The 1st surgery was 2 artificial discs replacements c4c5 n c5c6. Then, 2nd surgery was fusion on c6c7 anterior approach and also spacers were put in between c4 through c6 posterior approach. None of these surgeries stopped the burning pain on my left wrist backside of my hand in an area about 4 inches long and 2 inches wide nor did it stop the same burning feeling in my left bicep. I'm 51 and probably was in the best shape of my life until I was hit from behind while waiting at a stoplight in my car by another car speeding. Any suggestions on what could be causing this extreme burning pain would help? You know, maybe something these 2 different doctors overlooked. Thank you
Hi Mr. Sanchez, I'm afraid it is difficult to give you specific guidance since I haven't reviewed any of your imaging, history or exam. It seems like you have had a significant amount of cervical spine surgery so I am assuming that the spinal cord and nerves have been adequately decompressed (I am assuming that). I hope that you have had an EMG/NCS to evaluate your nerve function and exclude a peripheral nerve problem -- if not I would definitely get that. I can't offer much more guidance than that unfortunately; sometimes nerves don't fully heal but I would discuss further with your spine surgeons or seek evaluation from another one who can give you more specific guidance after reviewing your images, history, symptoms and exam. Good luck, SP
Thank you. Had this procedure 2 months ago at the VA for C3 - C6. Definitely worth it. Waking up from surgery I could feel warmth in my hands and feet for the first time in two years. It is so nice not to have cold hands and feet. I've had a few bouts of normal, balanced walking which lasted a few hours and that was great . Was able to move and walk around much faster. Looking forward for more improvement. My neurosurgeons say it can take 6 months. I can wait, it's been years since I could do chores without dropping things and losing balance all the time. The lack of balance was so bad I'd get nauseous from motion sickness. Thanks for the clear explanation and thoughtfulness. Oh, yes for anyone who's getting this you want to have Aspercreme w/4% Lidocane with the roller ball applicator and someone to put it on for you at least 2x a day. I have it put it on in a cross pattern to reduce tension and spasms. Helps me work and sleep
That's great! It sounds like you had great surgeons and I'm really glad you're doing well. thanks for watching! -SP
How soon did you start using that after your surgery please?
@@hmoser6416 About 2 weeks. When I could discern muscle pain from bone pain.
@@drewodessa2483Thank you
My doctor wants to do an ACDF at c4-c6 due to severe foramina stenosis at C5-6 but I’m too scared of my vocal cords getting damaged when they move them. Can the nerve pinching and pain/weakness down my arms be fixed by this posterior procedure and will that eliminate the risk of vocal cord damage?
I’m a singer and public speaker and I’d rather be paralyzed in a wheelchair than lose my voice. i couldn’t speak for 3 years for psychological reasons and it was torture. I felt like i was in an isolation ward. So i have to find a different solution than an ACDF. I’ve heard of too many people left with permanent hoarseness to make me want to risk it
That's very interesting. Ordinarily, dependency on vocal function is a legitimate consideration in selecting surgical approach. There are different posterior options depending on your symptoms, imaging and the goals of surgery. PCDF is an option if central decompression is warranted, if there's instability, if there are bilateral symptoms and if many levels need to be done. Another option is a posterior cervical foraminotomy which is generally good for one or two levels and unilateral symptoms of nerve root compression. It is certainly worth discussing with your surgeon. Good luck! -SP
@@prasadspineacademy thank you!! This is what my report says. I don’t know if you’re able to tell from that if a posterior option would help enough.
Alignment: Minimal stable retrolisthesis C3 with respect to C4. Minimal stable anterolisthesis of C4 with respect to C5. Mild stable retrolisthesis of C5 with respect to C6. No significant malalignment. No fracture. No significant prevertebral soft tissue swelling. No altered signal intensity within the posterior ligamentous structures.
Marrow signal: Moderately severe discogenic endplate changes C5-6. Mild discogenic endplate changes C3-4. Otherwise no focal marrow signal abnormality.
Spinal cord: No cord signal abnormality. No focal cord atrophy. No swelling. No focal intradural or extradural masses.
Intervertebral discs: Disc space narrowing C3-C4, C5-6 and C6-7 levels.
Axial images demonstrate the following:
C2-C3: No focal disc protrusion. No nerve root compression. No cord compression.
C3-C4: Mild disc bulge. Mild bilateral uncovertebral joint arthropathy. Mild effacement anterior aspect of the thecal sac. No cord compression. Mild bilateral neural foraminal narrowing. No nerve root compression. No significant facet joint arthropathy.
C4-C5: No focal disc protrusion. No nerve root compression. No cord compression. No significant right-sided facet joint arthropathy. Moderate left-sided facet joint arthropathy.
C5-C6: Moderate broad-based disc bulge. Mild bilateral uncovertebral joint arthropathy. Mild bilateral facet joint arthropathy. Moderate effacement anterior aspect of the thecal sac. Disc osteophyte complex abuts the anterior cord. Severe right-sided neural foraminal narrowing with probable compression right C6 nerve root. Moderate left-sided neural foraminal narrowing without definite evidence for left-sided C6 nerve root compression.
C6-C7: Mild broad-based disc bulge. Mild bilateral uncovertebral joint arthropathy. Mild effacement anterior aspect of the thecal sac. No cord compression. Mild to moderate right-sided neural foraminal narrowing without definite evidence for right C7 nerve root compression. Mild left-sided neural foraminal narrowing. No left-sided C7 nerve root compression.
C7-T1: No focal disc protrusion. No nerve root compression. No cord compression.
IMPRESSION:
Multilevel degenerative disc disease and degenerative facet joint arthropathy as discussed in detail above. Findings most marked at the C5-6 level.
Interval progression in severity of findings at the C5-6 level as compared with the previous study.
I can't really tell what I would do from that report alone but if surgery is warranted it does sound like an anterior approach makes sense from a strictly structural perspective. Good luck, SP
@@prasadspineacademy thank you for your help!!
Great video. Very clear. Question: scheduled for. Laminectomy in C3-T2 due to ASD after an ACDF in C4-6 11 years ago. Extremely concerned about the post operative pain management.
Thank you! Good luck. There is a fair amount of pain in the short run after that surgery but it is usually well controlled with pain medications, muscle relaxants, etc. In the medium to long term the pain should improve substantially or fully resolve. Good luck!
Hi dr, i have c2 c3 sever compression, without serious symptoms, but t2 signial, what you advice me, please?
I would definitely advise you to seek an evaluation with a qualified spine surgeon. T2 signal is usually indicative of some degree of spinal cord dysfunction but a good exam is paramount to making this diagnosis. Surgery may be advisable but that is only really determined with a good physical examination, review of your symptoms and imaging. Good luck! -SP
Hi doc for such operations how much cost of it and will the patient return to his normal life after laminectomy operating
I don't know what the cost is all-in between the surgeon and hospital, implants, etc. It depends on the country and many other factors. -SP
Hi, I have Stenosis C4 C5 C6 and also a slip at C3, and having a laminectomy in 3 weeks, I also have a 8mm Chiari Malformation which they were going to operate on first but have now decided to do the posterior laminectomy. And not do CM at all. I am awaiting a letter telling me what they are going to do exactly but phone call from surgeon a fusion wasn't mentioned. I live in Scotland and NHS is on its knees and people not getting what they need. My question is , is there any reason why they would not do a fusion? as i believe can cause instability if not done. Thank you Michelle.
Hi Michelle, thanks for reaching out. I'm afraid I can't offer specific guidance on your clinical circumstances. I can say in general that most posterior cervical decompressions are now performed with instrumentation and fusion in the United States. Historically, uninstrumented posterior cervical decompressions were routine and it is not unreasonable in certain circumstances. I principally reserve this procedure for elderly patients with a lot of spondylosis, preservation of lordosis and concern for anesthesia duration and blood loss. Having said that, it sounds like a more detailed conversation with your surgeon is in order. Good luck! -SP
@@prasadspineacademy Thank you for your time .Michelle .
Could you please explain posterior fusion failure syndrome, why it occurs, and what are the methods to fix it.
I will try to make a video on that but "Failure" can be an ambiguous term. It most often means that the fusion didn't heal. It can also reference adjacent segment disease/degeneration, persistent radicular symptoms, exposure-related persistent pain, etc. -SP
@@prasadspineacademy Thank you! Specifically to the cervical region if you will.
All these patients need one procedure, the Deuk Laser Disc repair. No need to take out ligament or bone. No pain medications afterwards. And zero chance of adjacent segment problems. I wish more of you prominent surgeons would look into this. I know it will not make the same money that the companies pay you to put in hardware and doing the fusion does, but it is so much less invasive and accomplishes 100% relief of any radiculopathy and neck pain.
I appreciate and respect your opinion. Part of the reason I am developing this channel is to provide an honest, evidence-based resource that explains pathology and treatment options. It is not meant to sell any particular procedures or technologies. Spine surgery decision-making requires detailed and thoughtful consideration -- there is no singular technique or approach that works for everyone and there is no technique that achieves "100% relief on any radiculopathy and neck pain". Suggesting otherwise is misleading, whether you are a surgeon, a patient or anyone else. You may believe in the Deuk Laser Disc repair, and I respect that. Please show me the peer-reviewed evidence for this technique. Also, let me know what insurances pay for that procedure. In my region, surgeons that perform laser disk repair require cash or out-of-network payment -- doesn't sound as altruistic as you suggest.