Posterior Cervical Laminectomy and Fusion

What is Posterior cervical laminectomy and fusion?

Injury or wear-and-tear can cause parts of the cervical vertebrae in the neck region to compress the nerves of the spinal cord, leading to pain, numbness, or tingling in the part of the body that the nerve supplies.

Posterior cervical laminectomy and fusion is a surgical procedure performed through the back of the neck to relieve pressure over compressed nerves in the cervical spine region caused by inflamed spinal tissue or nerves. The procedure removes portions of the cervical vertebrae causing compression of the spinal cord and nerves, followed by fusion of the adjacent vertebrae to restore spinal stability.

Anatomy of the Cervical Spine

The spine is made up of 33 small bones called vertebrae and is known as the spinal column or vertebral column. It can be divided into 5 parts: cervical, thoracic, lumbar, sacral, and coccyx region. The cervical spine is comprised of the first 7 vertebrae (C1-C7), which support the neck and the head. The vertebrae are protected by spongy vertebral discs that are present in between them and are supported by ligaments that hold them together and surround the underlying spinal cord. Damage or degeneration of the vertebral bodies or discs can lead to nerve compression causing pain, weakness, or numbness.

Indications

Spinal stenosis is one of the major indications for undergoing a posterior cervical laminectomy and fusion. Spinal Stenosis involves the narrowing of the spinal canal due to arthritic changes in the facet joints and intervertebral discs. This causes enlargement of the joint leading to pressure on the spinal nerves. Symptoms of spinal stenosis include back pain or radiating pain into the hips, buttocks or legs, numbness or muscle weakness, and tingling sensations in the back and lower extremities.

Causes of spinal stenosis include:

• Degenerative spinal conditions such as herniated discs.
• Osteophytes or bone spurs.
• Cervical fractures.
• Tumors.
• Infection.

Preparation for Surgery

Preoperative preparation for posterior cervical laminectomy and fusion will involve the following:

• Your doctor will review your medical history and perform a thorough examination.
• Diagnostic tests such as blood work and imaging will be ordered.
• You will need to refrain from medications such as blood thinners, aspirin, or anti-inflammatory drugs for a week or two prior to surgery.
• Avoid alcohol or tobacco at least 24 hours prior to surgery.
• Do not consume any solids or liquids at least 8 hours prior to surgery.

Surgical procedure

Posterior cervical laminectomy and fusion are usually performed under general anesthesia. During this procedure:

• You will lie face down on the operating table.
• Your surgeon makes an incision over the back of the neck, at the level of compression.
• The muscles and the soft tissues are retracted to expose the lamina or roof of the vertebra.
• A section of the lamina or the entire lamina is removed to eliminate the pressure on the spinal cord and nerve roots.
• In addition, any other sources of compression such as bone spurs, or damaged discs are also removed to relieve nerve compression.
• Spinal fusion is then performed in which a bone graft or bone graft substitute is inserted in the place of the removed vertebral body or discs to fuse the adjacent vertebrae and preserve the normal height of the vertebral column.
• Rods, plates, and screws are fixed to the treated vertebrae for additional support and stability during the fusion and healing process.
• At the end of the procedure, your surgeon realigns the muscles and soft tissues, and the incision is closed with sutures and covered with sterile bandages.

Postoperative care

In general, postoperative care instructions and recovery involve the following steps:

• You will be transferred to the recovery area for observation where a nurse will monitor your vital signs as you recover.
• You may need to stay 1 to 3 days in the hospital.
• You will most likely be able to get out of bed and walk around on the same day of your surgery.
• A neck brace may be recommended for a few weeks to restrict the movement of the neck and promote healing.
• Medications are provided as needed to manage pain, swelling, and infection.
• Instructions on diet, bathing, driving, and surgical site care are provided.
• An individualized physical therapy regimen is designed to help strengthen your spine muscles and optimize spine function.
• Avoid strenuous activities, twisting, or lifting heavy weights for at least a month.
• A gradual increase in activities over a period of 4 to 6 weeks is recommended.
• You will be able to resume your normal activities in a couple of months; however, return to sports may take anywhere from 3 to 6 months.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Some of the risks and complications of posterior cervical laminectomy and fusion include:

• Infection.
• Pain.
• Nerve damage.
• Bleeding.
• Blood clots.
• Spinal fluid leakage.
• Bowel and bladder problems.
• Fusion failure.
• Anesthetic risks.