Le cervical spine is a complex and compact anatomical structure of the human body. He rocks several biomechanical functions. It supports the weight of the head and allows its mobility. It also contains the spinal cord.
La management of nerve compression ou spinal cord cervical spine has evolved a lot over time. This has moved from so-called conventional techniques to new instrumentation and new grafting techniques (arthrodesis). In this article, we will see some practical advice living with cervical arthrodesis.
Definition
THEcervical arthrodesis is a surgical act which involves welding or fuse together several vertebrae, thanks to metallic material (screws, plates, rods). This is done by placing a wedge filled with synthetic bone grafts or from bone removed during surgery. Most often, this bone is taken from the pelvis. While the fusion is taking place, the practitioner inserts pedicle screws and plates or rods on either side of the joint.
The objective of the operation is to release the compressed nerve root by serious fractures or sprains of the cervical spine or by cervico-arthritic myelopathy. This helps relieve the neuralgic cervico-brachial pain that the patient feels.
Cervical arthrodesis is applied when medical treatment does not work.
Depending on the surgical approach, there are two categories of interventions.
- The anterior procedures, with a scar in front of the neck.
- The posterior procedures, with a scar behind the neck.
Each approach has advantages and disadvantages. However, anterior procedures have the advantage of not damaging the muscles, which reduces the risk of postoperative pain.
The surgical act takes place under general anesthesia. The procedure lasts about two hours. Hospitalization is for 24 to 72 hours after the operation.
To learn more about cervical arthrodesis, see the following article: Cervical arthrodesis (indications and postoperative course).
Recovery following cervical arthrodesis
During a cervical arthrodesis surgery, postoperative follow-up can be quite heavy.
The duration of hospitalization is 48 hours on average, in the absence of the appearance of intercurrent events. Getting up is authorized on the first postoperative day. Doctors also recommend starting walking at this time.
Le return home is possible after removal of the drain (if placed during the operation).
The dressing should be redone every 48 hours, until the wound has healed.
As for the medical check-up, the first consultation takes place at 6 weeks. Then there will be another after 3 months of the operation. The latter will be used to judge the progress of the intervention (clinical and radiological controls). If the pain persists, the doctor may extend the duration of the follow-up.
La physiotherapy begins around the 45e jour, with gentle massages then stretching and finally remusculation. It is gradual and should be painless. The advantage is that patients recover their mobility very quickly. Ultimately, all physical activities can be resumed once the graft has consolidated.
Prognosis after cervical arthrodesis
La cervico-brachial neuralgia pain disappears quickly after the surgery. The risks of neurological complications exist, but they are extremely rare.
One of the biggest advantages of this intervention is the possibility of having a gradual return to normal life.
Away from the arthrodesis, one can see the appearance of a pseudarthrosis. However, this is not always symptomatic and therefore does not systematically require revision surgery. In addition, there may be degeneration of adjacent discs at the fusion level in the years that follow.
Practical advice after cervical arthrodesis
- Anticipate pain by taking painkillers for at least 24 hours.
- It is recommended for the patient to wear a neck brace for pain relief during the first months. Of course, each situation is unique, so the recommendations will be personalized on a case-by-case basis.
- The patient's normal life can be resumed by avoiding any physical exertion for the first few months.
- Throughout the recovery period, it is necessary avoid to efforts. For at least 3 months, it is contraindicated to carry heavy loads (from 4-5 kg) and to perform extreme movements of the neck. The neck should not be bent and/or turned excessively, especially if this causes pain or discomfort.
- A work stoppage of 3 months is generally necessary, but can be adjusted according to the profession exercised by the patient.
- Count on average 4 months after the intervention for a resumption of professional activity. It must be done in a reasoned and reasonable manner. It depends on the patient's age, his profession (in particular the need to perform repeated movements or carry heavy loads) and his travel time.
- La resumption of driving is possible within 3 to 4 weeks. However, before you get started, it is imperative to have previously recovered certain movements of the neck, including rotation. This is essential in order to be able to carry out checks in the exterior mirrors. The decision should also be discussed with the surgeon once the postoperative pain has subsided.
- La resumption of sporting activity is also feasible after the 3rd month. You just have to favor sports without impact on the neck and avoid those that require a twisting maneuver (swimming, cycling, brisk walking, etc.).
- You should consult your doctor if new symptoms appear, such as pain, numbness, muscle weakness, paralysis, etc.
- Whenever possible, avoid kinesiophobia (ie, fear of movement). Do not overprotect the cervical region, especially in the long term (at the risk of developing stiffness and weakness).
- Pay attention to posture, and exercise regularly (taking into account the recommendations of the physiotherapist).
- Leisure activities can be resumed without limitation after fusion of the graft. However, the professional activities of force must be adapted, and it is often necessary, in this category of trade, to call on a social worker to know the possible steps.
References
https://hopital-prive-jean-mermoz-lyon.ramsaysante.fr/arthrodese-cervicale-anterieure
https://www.groupe-chirurgical-thiers.fr/rachis/arthrodese-cervical-anterieure/
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