There are many people in China, even some doctors in internal medicine, massage and Chinese medicine, who will talk about cervical spine surgery – cervical spine surgery is a great risk of paralysis and cannot be done, causing a great psychological burden to patients who need surgery for cervical spine disease. Since these doctors are not specialists in the treatment of cervical spine disease and have no experience in cervical spine surgery, the advice given is inevitably biased and taken for granted.
In fact, for hospitals featuring cervical spine surgery and for cervical spine surgery specialists with mature technology, this hardly happens and more than 80-90% of patients benefit from the surgery. I have performed more than 1,000 cervical spine surgeries, which are generally very reliable and safe, and the number of patients receiving surgical treatment has increased significantly in recent years. A decade ago, I performed dozens of cervical spine surgeries a year, but now I perform about 300 cases a year. There are three main reasons for this change.
1, the aging of the population;
2, the great progress of surgical technology, the specialist brand effect;
3, the improvement of examination equipment and the majority of patients understand and accept the effect of surgery.
Scientifically speaking, the risk of cervical spine surgery cannot be generalized and is related to several most important factors – condition and diagnosis, surgeon’s awareness and experience, surgical access and modality, hospital conditions and equipment, overall level and responsibility of the medical staff in the ward, and patient’s understanding and cooperation in disease treatment.
I. Condition and diagnosis
For the same cervical spine surgery, the reasons for surgery vary, and the condition and diagnosis directly affect the difficulty and success rate of surgery; risky cases account for very few of the overall cervical spine surgeries. Common conditions with high surgical difficulty and risk include – extensive cervical tumors, severe ossification of the posterior longitudinal ligament (OPLL), cervical fracture dislocation spinal cord injury with peak edema, severe long-segment cervical stenosis, complex lesions of the upper cervical spine, and posterior convex deformity of the cervical spine, etc. These difficult injuries and conditions account for about 5-10% of total surgeries, while The vast majority of the others are general cervical spondylosis, disc herniation, fracture dislocation, OPLL, cervical spinal stenosis, etc., and the reliability of surgery is relatively much higher.
High risk factors for surgical treatment of cervical spondylosis include
1.Severe cervical spinal stenosis, long delay before surgery, heavy disease, nerve adhesions;
2, the patient is old and frail, and the incidence of complications after surgery is relatively high in patients over 70~80 years old;
3, preoperative patients with serious combined diseases, diabetes, cardiovascular and cerebrovascular diseases, liver and kidney insufficiency, etc., which will increase the probability of complications in the perioperative period.
Domestic and foreign bulk data (similar to our observations) show that the efficiency of cervical spine disease is around 80-90%, but about 10% of patients still have insignificant surgical results, and the analysis is directly related to the fact that some nerves have degenerated and necrosis. All cervical spine surgery patients together statistics, curable surgical complications are generally in 5-10%, permanent nerve loss (paralysis or obvious loss of limb function) is around 0.3%, and the incidence of death due to surgery and hospitalization complications is around 0.2%.
Second, the doctor’s awareness and experience
What kind of doctors can better ensure the safety of surgery to reduce the risk? A professional doctor, a mature doctor, a young and strong doctor, a bold and careful doctor, a caring doctor, a doctor with clinical and surgical experience, a physically healthy doctor, a practical doctor, a clean and honest doctor, yes, it is no exaggeration to say that the surgeon in charge of cervical spine surgery should have these excellent qualities and qualities, and only such a doctor can really reduce the risk of surgery.
Of course, no doctor can reduce the risk to 0, but a good doctor always pursues excellence to have less problems than others, pursues positive face and problem solving, pursues the patient as a comrade to resist the risk together – full communication and honest face to do something.
Third, the access and mode of surgery
Severe ossification of the posterior longitudinal ligament is risky from the anterior approach and less risky from the posterior approach; cervical fracture dislocation spinal cord injury edema peak surgery is risky and avoiding edema peak is less risky; surgical steps are complicated and risky and the surgical approach is concise and less risky …… Almost most critical and difficult cases have a way to resolve the risk, but of course, the key may be in the hands of the doctor, which is both a problem of awareness and a technical problem. In short, the surgical access is closely related to the surgical approach and surgical safety.
Fourth, the condition equipment of the hospital
MRI and CT examination equipment, special instruments for surgery, high-speed grinding drill, autologous blood transfusion equipment, postoperative monitoring equipment, reasonably designed and good quality internal fixation equipment …… These are the key equipment for smooth cervical spine surgery, complete is safe, shortage is risky.
V. The overall level and responsibility of the medical and nursing staff in the ward
Medical safety needs excellent medical care team to ensure. Postoperative observation of the condition should be careful, and the staff on duty should be responsible, so that problems can be detected and dealt with in a timely manner, and individual postoperative critical situations can be turned into safety and danger into success. Overall, most of the complications will be successfully recovered with early treatment.
Sixth, the patient’s understanding of the disease surgery treatment and cooperation
Understand their condition, understand the main principle and purpose of treatment, recuperate and exercise according to medical advice, provide necessary and sufficient economic and psychological preparation, communicate with doctors, ask questions and make requests in a timely manner …… These are also necessary conditions for a successful recovery.