【Major points】
- Cervical neuro-regeneration surgery is to decompress and repair the injured spinal cord through a microscope, cooperate with active rehabilitation after operation to improve the function of injured nerves.
- If you are taking anticoagulant medication or medications that needs to be taken daily, such as antihypertensive agents, please inform your doctor when you addmitted to evaluate whether you need to take them.
- Nursing staff will guide you on postoperative drainage tube and postoperative wound care, correct wearing of collar, change position and precautions for postoperative activities.
一、What is cervical neuro-regeneration？
The traditional spinal surgery involves decompression and fixation of vertebral bodies outside the spinal cord, while the cervical neuro-regeneration surgery is to open the spinal dura and use a microscope to decompress and repair the injured spinal cord.
The traditional spinal surgery involves decompression and fixation of vertebral bodies outside the spinal cord, while the cervical neuro-regeneration surgery is to open the spinal dura and use a microscope to decompress and repair the injured spinal cord.
二、Why is this surgery needed?
Use new medical technology to repair damaged cervical nerves, so that the scope of spinal cord injury can be controlled and will not continue to expand. At the same times, with active rehabilitation treatment, the nerve function can be restored and improved, so as to achieve the goal of nerve repair.
Use new medical technology to repair damaged cervical nerves, so that the scope of spinal cord injury can be controlled and will not continue to expand. At the same times, with active rehabilitation treatment, the nerve function can be restored and improved, so as to achieve the goal of nerve repair.
三、Preparation before surgery:
During the outpatient clinic, medical staff will assist patient to complete relevant examinations, including spinal series X-Ray, CT or MRI, electromyography , sensory and motor evoked potentials, urodynamic and other neurological related examinations. Arrangements will be made after hospitalization, such as electrocardiogram, chest X-ray, blood test, etc.
- During the preoperative meeting, The doctor will explain the procedure, purpose, and complications of the surgery to the patient and family. Afterwards, the patient shall fill in the operation consent, anesthesia consent, blood transfusion consent and payment consent.
- Prepare a suitable collar according to the doctor's instructions for daily activities after surgery.
- The doctor will mark the surgical site before surgery, Please do not wash it off.
- If you have problems with constipation and have not poop for several days, please tell the staff to have an enema to help you empty your bowels before surgery.
- If you are taking anticoagulant medication or medications that needs to be taken daily, such as antihypertensive agents, please inform your doctor in advance to evaluate whether you need to take them.
- To avoid adverse effects of anesthesia, avoid eating or drinking after midnight before surgery.
- On the morning of the surgery, the patient will change into the surgical gown. Also remove dentures, glasses (including contact lenses), nail polish, watch and jewelry.
四、Principles of care after surgery:
- After surgery, the patient will have wound drainage, such as intravenous catheters, urinary catheters, etc. All of these drains will be removed when the patient is stable,. Do not pull out the tube by yourself as this may cause injury.
- After returning to the ward, if the patient does not experience nausea or vomiting, and has normal bowel movements, the patient can follow the oral intake instructions. You can drink water first and then eat normally if there is no discomfort.
- For postoperative wound pain, the doctor will prescribe analgesics to relieve pain.
- To prevent pressure injuries, the nurses will assist the patient to turn over with turning sheet every two hours.
- The collar needs to be used immediately after the operation. The nurse will guide you on the correct way of wearing the collar. The length of time to wear the collar is determined by the doctor, usually at least three months.
- You can start bedside joints range of motion on the first day after surgery.
- Get out of bed as directed by your doctor. The nurse will help you do it.
五、Home care considerations:
- Keep the wound clean and dry. If there is redness, heat, or severe pain, return to the hospital immediately.
- Stitches will be removed around 7 to 10 days after surgery. If the patient has diabetes mellitus, it may be longer, depending on the healing. After stiches removed, steri-strips could be put on to avoid scarring.
- Bowel training: A high fiber diet, medications, abdominal massage, anus stimulation and enema can maintain and promote defecation.
- Bladder training: Adjust the duration of intermittent catheterization according to the patient's bladder capacity and residual urine volume. If the residual urine volume is less than 100 ml within two weeks, or the ratio of self-urination to residual urine is less than 3:1, catheterization can be stopped. It will be based on the results of the urodynamic examination. The doctor will perform renal function and urodynamic tests as needed by the patient.
- Training for motor and sensory function:
- weeks 0-2: Massage the lower limbs on both sides and perform passive movement of all joints to maintain the range of motion of the hip, knee and ankle joints.
- weeks 2-4: Increases passive range of motion, accompanied by active joint movement. Train the patient's bladder and defecation function
- weeks 4-8: Continue active movement of joints. Strengthen four limbs and keep range of motion accordingly. At this stage, patients can arrange rehabilitation programs at the clinic.
- months 2-12: The patient continues to undergo rehabilitation in the hospital near the home, and is followed up by the neurological repair outpatient clinic every month. The physician conducts neurological examination, neuroelectrophysiological examination, and bladder and colorectal function examination as necessary to evaluate motor function.
Reference
- Gharooni, A. A., Kwon, B. K., Fehlings, M. G., Boerger, T. F., Rodrigues-Pinto, R., Koljonen, P. A., Kurpad, S. N,. Harrop, J. S., Aarabi, B., Rahimi-Movaghar, V., Wilson, J. R., Davies, B. M., Kotter, M. R. N., & Guest, J. D. (2022). Developing novel therapies for degenerative cervical myelopathy [AO Spine RECODE-DCM Research Priority Number 7]: Opportunities from restorative neurobiology. Global Spine Journal, 12(1_suppl), 109S-121S. https://doi.org/10.1177/21925682211052920
- Shah, M., Peterson, C., Yilmaz, E., Halalmeh, D. R., & Moisi, M. (2020). Current advancements in the management of spinal cord injury: A comprehensive review of literature. Surgical Neurology International, 11, 2. https://doi.org/10.25259/SNI_568_2019
- Sharma, A., Sane, H., Gokulchandran, N., Badhe, P., Paranjape, A., Kulkarni, P., & Nair, V. (2019). Neuroregenerative-rehabilitative therapy for spinal cord injury. in spinal cord injury therapy. https://doi.org/10.5772/intechopen.88808
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