After someone has suffered a spinal cord injury, it is important to stabilize the bones of the spine to prevent further injury. Sometimes just wearing a brace for several months while bones and ligaments heal can do this.

Often, however, surgery is needed to help keep the bones in position while they heal.  It should be understood that that surgery will not change how the spinal cord itself heals.

After surgery

Some people will likely spend time in an intensive care unit (ICU) after spine surgery. This includes anyone who needs support for breathing from a ventilator or special intravenous (IV) medications for blood pressure.

People who were on an acute care unit before surgery will most likely return there. Sometimes an ICU is needed just for overnight observation. Your doctors and nurses will tell you what to expect.

It is very common to need a cervical collar or other brace after surgery. The brace keeps you from putting stress on the healing muscles and bones. It will allow you to start getting out of bed within a day or so of surgery. If needed, physical and occupational therapists will also be able work more actively with you.

Your surgeon will tell you how long the brace must be worn (usually several months). Before you leave the hospital, you will learn what you need to know to live with the brace.

Based on how the bone injury looks on X-ray and other tests (CT scan and/or MRI), the surgeon will decide what approach is needed.

Surgery to stabilize the spine can be done from the back (posterior spine surgery) or from the front of the spine (anterior spine surgery). In some cases, both approaches may be needed, usually in two separate operations.

Anterior surgery

“Anterior” surgery does not mean doing the surgery from directly in front of the body. Usually it is done from the side so that the surgeon can reach the front of the spinal column. For example, anterior surgery on the thoracic spine is done through the side of the chest. After this kind of surgery, there will usually be a drainage tube called a chest tube coming out from the side of the chest. This prevents fluid from collecting around the lungs after surgery and stays in place for a couple of days.

Fusion

Another term that may be used to describe what will be done is “fusion.” A fusion procedure involves attaching metal screws, plates, or other devices to the bones of the spine to help keep them properly lined up. This is usually done when two or more of the spinal bones (called vertebrae) have been injured. As well as metal devices, other small pieces of bone may also be attached to the injured bones to help them “fuse” into one solid piece.

(Figure 1:  vertebrae fused together)

The bone used for this procedure is usually taken from another bone in the body – most often from the hip. This does not damage the hip, and makes the fusion more stable. If needed, a small surgery on the hip will be performed at the same time as the spine surgery.

As with any surgical procedure, there are risks involved.
Patients face greater risks from surgery if they:

• Are elderly
• Are overweight
• Smoke
• Have diabetes

Talk with your doctor about he any concerns you may have about surgery. The experts at both Harborview and University of Washington Medical Centers are leaders in their field and have many years of experience in treating your type of spinal condition.

Surgery may be recommended without delay if a person has cauda equina syndrome, symptoms of which include:

• Numbness or weakness that interferes with walking
• Impaired bowel or bladder function