Stroke symptoms and warning signs:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding, memory impairment.
• Sudden trouble seeing in one or both eyes, or visual field cut.
• Seeing double images, or drooping of one eyelid, or red and pulsating eye.
• Sudden dizziness, loss of coordination or balance, trouble walking.
• Sudden severe headache, with or without neck pain and back pain with no known cause.
• Sudden loss of consciousness
• Transient ischemic attacks (TIAs)

Transient ischemic attack (TIA)

Transient ischemic attack (TIA) is "warning stroke", is the strong predictor of a major stroke. It (TIA) is also often known as "minor stroke" that produce stroke-like symptoms but of no lasting brain damage. It is also caused by a mini-clot that cause transient blockage to blood vessels. As the blockage is transient, unlike a major stroke, there is no permanent damage to the brain. Nevertheless, TIA is an important signal of a major stroke. A person who's had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't. And 1/3 of people with TIAs experience a major stroke in the same year. Therefore recognizing and treating TIAs can reduce your risk of suferring a major stroke. TIA should be considered as medical emergency. It is essential to grasp TIA’s symptoms and followed up immediately with a stroke neurosurgeon, and should be treated in the same way as a stroke.

Lumbar spinal stenosis
Sacroiliac joint pain
Low back pain
Cervical Disc Hernia or Degeneration

Cervical Spine Surgery

Cervical spine surgery may be indicated for:

1. Neural decompression
2. Spinal stabilization
3. Tumour excision

Anterior Cervical Discectomy and Fusion is a common surgical procedure used to treat neck problems such as bulging, herniated disc, degenerative disc disease and spinal instability etc. Discectomy is the removal of the disc and any fragments between the vertebrae. After the disc is removed, the space is filled with a bone graft, the goal is to help the bones to fuse together into one solid bone. This is known as fusion. In order to provide stability during fusion, the doctor may reinforce a metal plate screwed into the vertebrae (cage, screw and plate).The expected outcomes of this operation are to treat for symptoms due to cervical spondylosis aims to relieve pain and prevent further permanent damage to your nerves. Your mobility of neck will be reduced after fixing the disc.

The operation is performed under general anaesthesia. The approach to the cervical spine may vary with individual patient. It can be accessed from the front or from the back. X-ray may be used in the operation room to confirm the level of operation.

Risks and Complications

1. Injury
   1. Larynx , the nerves to the larynx (recurrent laryngeal nerve) causing vocal cord paralysis and a hoarse voice. This is usually temporary.
   2. Carotid artery, which can cause a stroke resulting in permanent paralysis.
   3. Spinal cord resulting in temporary or permanent quadriplegia (paralysis of arms and legs).
   4. Nerve root causing upper limb weakness, sensory loss, or pain temporary or permanent.
2. Infection in the wound causing redness, pain and possible discharge or abscess.
3. Failure of fusion on the bone.
4. Persistent pain

After the patient is awaken from the anesthesia, oral feeding may be started. A normal diet may be resumed as instructed after recovery from anaesthesia. Make sure there is no difficulty in swallowing when resuming normal diet. After general anaesthesia, you may experience discomfort in the throat after tracheal intubation. The side effects of anesthesia including feel tired, drowsy, nausea or vomiting. Inform the nurse if symptoms persist or worsen. You should inform the nurse of wound pain. Proper pain relief treatment by injection or oral medication may be prescribed by the doctor.

Patient would be discharge in 1-2 days when the patient can take oral food and pass urine by himself / herself with health condition.

Advices on Discharge

1. Prescription pain medication may be taken as needed.
2. Recovery time for the wound generally takes 4 –6 weeks. Recovery of neurological symptoms started before surgery varies, depends on cause and severity of the symptoms.
3. You should avoid bending the head forward or backward.
4. Do not lift any heavy objects.
5. You may gradually return to normal activities. You should avoid sitting for long periods of time, walking is encouraged.
6. You usually wear a neck collar in the postoperative period, to hold the neck still in order to let the bone heal and fuse.
7. You may shower after discharge unless otherwise instructed. The dressing must be kept clean and dry. The stitches or staples will be removed during subsequent follow-up visit
8. You should immediately return to the doctor in the event of severe wound pain associated with redness and swelling, secretion of pus, massive bleeding or high fever over 38°C.
9. Any follow-up consultations should be attended as scheduled.

In special patient groups, the actual risk may be different. Other complications may occasionally occur. For further information please contact our spine surgeon.

Spine Overview

Intervertebral disc

The intervertebral disc serves to allow flexible movement of human spine and it also acts as a shock absorber or cushion.
It is composed of well-hydrated gel filled nucleus at its central and inner portion (like the same portion of a car’s tyre), and an outer annular fibrous layer (like the rubber outer layer of a tyre. 

A young and healthy disc

In many ways, the disc analogous to an automobile tyre. As long as the disc remains young, hydrated and being pressurized, it remains strong to support our body weight. A young and healthy disc will be revealed as a White Disc on MRI study of our spine in T2 image. 

 

An old and unhealthy disc

However, due to the following reasons:

1. Natural history of our body’s aging & degeneration after the age of 27.
2. Wear & tear due to our daily activities: e.g. prolonged sitting, weight bearing or lifting, sport impact, loading & twisting on our spine, etc.
3. Injury: sport or household injury, occupational or accidental injury, etc.

Our intervertebral disc may become dehydrated (water loss) or dry up at the central gel filled nucleus portion (become a black disc on MRI T2 images), it will depressurizes like to become an old flatten tyre.       

     

As soon as our disc depressurizes then problems may arise with the increased shear stresses developing on the outer side wall, just as one sees when a car tyre runs flat and fails. After then, depend on individual’s physical heath, various kinds of spine problem begin:    


  

Various kinds of spine symptoms:

1. Feeling of nausea, dizziness when spine at neck is affected.
2. Stiffness: spine became less flexible in neck or lower back.
3. Axial pain: headache, neck pain, back pain, etc.
4. Radicular pain at limbs: headache, shoulder, arm, buttock or leg pain i.e. sciatica pain, etc.
5. Radicular sensation disturbance: numbness, tingling, sense of needling, impaired sensation at shoulder, limbs, buttock, etc.
6. Radicular motor disturbance: muscle weakness at part of our limbs
7. Disturbed gait: Listing, limping, unsteady in walking, dragging foot while walking, unsteady and unbalancing gait, etc.
8. Frequency and weakness in urination, frequent urination at bedtime (nocturia), or even incontinance, etc.
9. Constipation, weakness in pass out stool or even bowel incontinence, etc.
10. Disturbed sexual or erectile function, etc.