What are the risks of anaesthesia and the general risks of surgery?
Having a general anaesthetic is generally fairly safe, and the risk of a major catastrophe is extremely low. All types of surgery carry certain risks, many of which are included in the list below:
Significant scarring (‘keloid’)
DVT (‘economy class syndrome’)
Pulmonary embolism (blood clot in lungs)
Chest and urinary tract infections
Pressure injuries to nerves in arms and legs
Eye or teeth injuries
Myocardial infarction (‘heart attack’)
Loss of life
Other rare complications
What are the implications of surgery?
Most patients are admitted on the same day as their surgery; however some patients are admitted the day before. Patients admitted the day before surgery include those who: reside in country regions, interstate, or overseas; have complex medical conditions or who take warfarin; require further investigations before their surgery; are first on the operating list for the day. You will be given instructions about when to stop eating and drinking before your admission.
You will be in hospital for between 1 and 3 days after your surgery. You will be given instructions about any physical restrictions that will apply following surgery, and these are summarised later in this section.
X-rays of your neck will be taken during surgery to make sure that the correct spinal level is being operated upon. It is critical that you inform us if you are pregnant or think you could possibly be pregnant, as X-rays may be harmful to the unborn child.
There is significant variability between patients in terms of the outcome from surgery, as well as the time taken to recover. You will be given instructions about physical restrictions, as well as your return to work and resumption of recreational activities. You should not drive a motor vehicle or operate heavy machinery until instructed to do so by your neurosurgeon.
You should not sign or witness legal documents until reviewed by your GP post-operatively, as the anaesthetic can sometimes temporarily muddle your thinking.
What do you need to tell the doctor before surgery?
It is important that you tell your surgeon if you:
Have blood clotting or bleeding problems
Have ever had blood clots in your legs (DVT or deep venous thrombosis) or lungs (pulmonary emboli)
Are taking aspirin, warfarin, or anything else (even some herbal supplements) that might thin your blood
Have high blood pressure
Have any allergies
Have any other health problems
What do I need to do before surgery?
Before you surgery it is imperative that you stop smoking.
If you are fairly overweight, it is advisable that you engage in a sensible weight loss program before you surgery.
In order to prevent unwanted bleeding during or after surgery, it is critical that you stop taking aspirin, and any other antiplatelet (blood-thinning) medications or substances including herbal remedies at least 2 weeks before your surgery.
If you normally take warfarin, you will usually be admitted to hospital 3 or 4 days before your surgery. Your warfarin will be ceased at that time (it takes a few days to wear off) and you may be commenced on shorter-acting anti-clotting agents for a few days. These can then be stopped a day or so before surgery.
Ideally, you should take a Zinc tablet a day, commencing one month before surgery, and continuing for 3 months after. This should help wound healing.
Will I need further investigations?
Most patients will have had X-rays of their neck, as well as a CT scan and MRI.
In some patients there is uncertainty either about the diagnosis or exactly which disc or discs in the neck are responsible for their symptoms: in those patients, nerve conduction studies and/or a nerve block may shed light on the diagnostic issues.
If you have not had an MRI for over 12 months before your surgery, or if your symptoms have changed significantly since your most recent MRI, then this investigation will need to be repeated to make sure that there are no surprises at the time of surgery!
Who will perform surgery? Who else will be involved?
Surgery will be carried out by your spine surgeon. A surgical assistant will be present and an experienced consultant anaesthetist will be responsible for your general anaesthetic.
How is a cervical foraminotomy performed?
A general anaesthetic will be administered to put you to sleep. A breathing tube (‘endotracheal tube’) will be inserted and intravenous antibiotics and steroids injected (to prevent infection and post-operative nausea). Calf compression devices will be used throughout surgery to minimise the risk of developing blood clots in your legs.
Your skin will be cleaned with antiseptic solution and some local anaesthetic will be injected.
The skin incision is about 3-5cm down the back of your neck. It is vertical and in the midline. The muscles at the back of the neck are gently separated from the spinal bones, and the bony roof over the spinal nerve is carefully removed using small drills and other fine instruments. Any soft tissue causing compression is also removed.
The spinal nerve is decompressed once the bone and other tissues have been removed (this is known as a ‘rhizolysis’).
The wound is closed with sutures and sometimes staples.
What happens immediately after surgery?
It is usual to feel some pain after surgery, especially at the incision site. Pain medications are usually given to help control the pain.
Most patients are up and moving around within a few hours of surgery. In fact, this is encouraged in order to keep circulation normal and avoid blood clot formation in the legs. You will be able to drink after 4 hours, and should be able to eat a small amount later in the day.
You can be discharged home when you are comfortable (usually after 2 or 3 days).
What happens after discharge?
You should be ready for discharge from hospital 2-3days after surgery. Your GP should check your wounds 4 days after discharge. Your staples require removal around 10 days after surgery, and this can be done by your GP.
You will need to take it easy for 6 weeks, but should walk for at least an hour every day.
Bear in mind that the amount of time it takes to return to normal activities is different for every patient. Discomfort should decrease a little each day. Increases in energy and activity are signs that your post-operative recovery is progressing well. Maintaining a positive attitude, a healthy and well-balanced diet, and ensuring plenty of rest are excellent ways to speed up your recovery.
Signs of infection such as swelling, redness or discharge from the incision, and fever should be brought to the surgeon’s attention immediately.
You will be reviewed after 6-8 weeks. Until then, you should not lift objects weighing more than 2-3kg, and should not engage in repetitive neck or arm movements.
You should continue wearing your TED stockings for a couple of weeks after surgery.
Detailed discharge instructions are as follows:
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What do I need to tell my surgeon about after the operation?
You should notify your surgeon and should also see your GP if you experience any of the following after discharge from hospital:
- Increasing arm or leg pain, weakness or numbness
- Worsening neck pain
- Problems with your walking or balance
- Swelling, redness, increased temperature or suspected infection of the wound
- Leakage of fluid from the wound
- Pain or swelling in your calf muscles (ie. below your knees)
- Chest pain or shortness of breath
- Any other concerns
What are the results of surgery?
Overall, 80-90% of patients will obtain a significant benefit from surgery, and this is usually maintained in the long term.
Generally, the symptom that improves the most reliably after surgery is arm pain. Neck pain and headaches may or may not improve (very occasionally they can be worse). The next symptom to improve is usually weakness. Your strength may not return completely back to normal, however. Improvement in strength generally occurs over weeks and months. Numbness or pins and needles may or may not improve with surgery, due to the fact that the nerve fibres transmitting sensation are thinner and more vulnerable to pressure (they are more easily permanently damaged than the other nerve fibres). Numbness can take up to 12 months to improve.
What are the costs of surgery?
Private patients undergoing surgery will generally have some out-of-pocket expenses.
A quotation for surgery will be issued, however this is an estimate only. The final amount charged may vary with the eventual procedure undertaken, operative findings, technical issues etc.
Separate accounts will be rendered by the anaesthetist and sometimes the assistant, and hospital bed excess charges may apply. Medical expenses may be tax deductible (you should ask your accountant).
You should fully understand the costs involved with surgery before going ahead, and should discuss any queries with your surgeon.
What is the consent process?
You will be asked to sign a consent form before surgery. This form confirms that you understand all of the treatment options, as well as the risks and potential benefits of surgery. If you are unsure, you should ask for further information and only sign the form when you are completely satisfied.