Posterior Cervical Laminectomy and Fusion

Posterior cervical laminectomy and fusion are surgical procedures performed to relieve spinal cord and/or nerve root compression that can be caused by disorders, including degenerative disc disease, herniated disc, spinal stenosis, and spondylosis. The purpose of posterior cervical laminectomy and fusion is to reduce neck and/or arm pain and stabilize the spine. Depending on your medical history, diagnosis, previous treatments, and other factors you may be a candidate for the minimally invasive version of this procedure.

To help you understand laminectomy, let’s separate laminectomy into two: lamina and ectomy.

Lamina – Located at the back of the spine, the cervical lamina are thin bony plates between each facet joint in the neck.  The laminar plates are part of the bony wall that covers and protects the spinal canal.  Within the spinal canal are the spinal cord and nerve rootlets.

Ectomy means to remove.

Your spinous processes are bones that project off the back of your spine. You can feel the end of most of your spinous processes by moving your hand up or down your spine.

Purpose of Cervical Laminectomy

The purpose of a laminectomy is to decompress-take pressure off the spinal cord and nerve roots.  During a laminectomy, the lamina is removed. In addition, the spinous process may be removed or trimmed to open the spinal canal and give your neurosurgeon access to the spinal cord and nerve roots.

• A cervical laminectomy may include a partial or complete discectomy. Sometimes a herniated disc encroaches into the spinal canal and presses on the spinal cord and nerve roots.
• Degenerative spinal disorders may contribute to thickening of spinal ligaments. The ligamentum flavum is a series of yellow ligaments that vertically connects your spinal column. Thickening of this ligament can cause it to buckle and press on the spinal cord and nerve roots.

Your surgery includes fusion. Fusion involves using bone graft to stimulate bone to heal and fuse solid. Autograft is your own bone, and allograft is donor bone. Your neurosurgeon may combine autograft with allograft.

Your neurosurgeon may include instrumentation with your fusion. Instrumentation is medical implants and devices such as plates, pedicle screws, and rods. Bone graft is packed into and around these implants to stimulate your spine to heal and fuse solid. Instrumentation provides immediate spinal stabilization and helps to eliminate micro-motion that can interfere with fusion success.

Before your posterior cervical laminectomy procedure

Well in advance of your surgery day, your neurosurgeon explains how he performs your procedure.  During the discussion, you learn if your procedure can be performed as a minimally invasive spine surgery or open approach, and why.

Before surgery, you visit your primary care doctor or general practitioner to obtain a general health clearance. This means your doctor has carefully evaluated your health in terms of undergoing surgery.  Your assessment may include blood tests, x-rays or other imaging studies, as well as special tests for existing medical problems (i.e., diabetes, heart disease).

Review potential benefits and risks of laminectomy

Of course, the potential benefits of surgery are important to know, but so are the possible risks and complications. Your risks and complications may be different from those of another patient because you are unique. Your neurosurgeon takes that into serious consideration and thoughtfully explains potential risks to you, which may include infection, bleeding, reaction to anesthesia, and nerve damage.

Posterior laminectomy and fusion surgical information

Posterior cervical laminectomy and fusion are performed under general anesthesia. Throughout your procedure, the neurosurgeon and his surgical team are kept current about your vital functions, including your central nervous system. Many different gauges, monitors, and equipment provide visual and audio feedback to the surgical team. Image guidance (real time x-ray; fluoroscopy) allows your neurosurgeon to see other views of the surgical field during (intra-operative) your procedure.

Basic surgical steps for laminectomy

• You are positioned face down on a padded surgical table. Your skull may be secured to a head brace that also keeps your neck from moving
• Real time x-rays are taken to confirm the cervical level
• Your neurosurgeon makes an incision at the back of your neck
• Muscle and other soft tissues are gently pulled aside to expose the lamina*
• The laminar plate and spinous process are removed to expose the spinal cord and nerve roots
• Disc, bone, ligament, and other tissues are trimmed or removed to further decompress the spinal cord and nerve roots
• If necessary, instrumentation is implanted with bone graft
• The incision is closed

*This is typical of a minimally invasive surgical technique wherein muscles and soft tissues are not cut.

After posterior cervical laminectomy and fusion

You are moved from the operating room into the recovery area. Here, the nurses and medical staff closely monitor your vital signs with attention to managing post-operative pain. You should expect some discomfort. You may have pain at the incision site, occasional neck muscle spasms, or other symptoms. When you wake up, you may be wearing a cervical brace.

Post-operative care for laminectomy

Your surgery is over, but now your recovery starts! If you do not understand your post-surgical instructions or a problem develops, please call us-we are here to help you.

Conventional post-spine surgery instructions

• Schedule your post-operative appointment call (281) 446-3876
• Wear your brace as instructed
• Keep your incision dry and clean
• You may shower, but keep your incision covered and dry
• Rest; you will fatigue easily while your body heals
• Do not take a tub bath, go swimming, or sit in a hot tub or pool
• Begin physical therapy and/or exercise as instructed
• Take medications as prescribed
• Do not lift or carry anything heavier than a shoe
• Walking is encouraged
• Do not drive until cleared by your neurosurgeon
• Avoid riding in a car; short distances are permitted
• Do not smoke or use tobacco
• Eat well, your body needs nutritious food to heal

Call your neurosurgeon’s office (281) 446-3876

• Fever 101 degrees Fahrenheit or higher
• Redness and/or swelling around the incision site expands
• Change in the amount, odor or appearance of the incision drainage
• Incision pain increases
• Bowel or bladder dysfunction develops
• Genital area numbness develops

Talk with your neurosurgeon

We hope this information about posterior cervical laminectomy and fusion has answered your immediate questions. Remember, your neurosurgeon is your most valuable source to answer your questions about symptoms, treatment and your healthcare.

You can also learn more about posterior cervical laminectomy and fusion from the following sources:

• Laminectomy on Wikipedia
• Decompressive Laminectomy for Spinal Stenosis