Cervical Laminectomy

This operation is performed through a vertical incision in the back of the neck, generally in the middle. Through this opening the surgeon will use an instrument (a retractor) to pull aside the strong muscles of the neck and expose the arch of bone (lamina) that forms the back of the spinal canal. Special instruments are used to remove the bone around the spinal cord or the bone around the nerve opening.

Indications for Cervical Laminectomy

• The most common reason is cervical myelopathy ( spinal cord compression), particularly when there is

1. acute or progressive muscle weakness, usually the legs
2. disabling loss of sensation
3. difficulty in walking

• Cervical laminectomy is also used for

1. tumors within and outside the spinal cord
2. trauma to the cervical spine
3. congenital stenosis (narrowing from birth) of the spine

• Disease at one or more spinal levels
• Carrying out the surgery from in front is difficult because of

1. failure of prior surgery
2. obesity, particularly with a short, stout neck

• The need to fuse the spine from behind
• The presence of a tracheotomy (opening into the windpipe) or other obstruction to an approach from in front

With advancing age, injury or surgical removal of a disk, several changes occur in the bone, disk, joints and ligaments of the cervical spine. These can produce neck and arm pain as a result of a nerve root being compressed or weakness and loss of feeling in the arm and legs because the spinal cord is compressed.

• Bones- With aging, bones tend to lose water and become less dense, a condition called spondylosis. These degenerative changes near the disk may cause an overgrowth of bone producing bony spurs (osteophytes) that can compress the spinal cord
• Disk- the discs also lose water and shrink thus narrowing the disk space.  As the disc becomes thinner the space between the vertebrae likewise narrows, which narrows the foramina causing nerve root compression and pain. As the disk space narrows, the contents of the disc begin to bulge and mushroom out causing pressure on the spinal cord.
• Joints - Along with the other degenerative changes, a degenerative arthritis of the facet joints can develop that causes the joints to enlarge, and form bone spurs.
• Ligaments - With advancing age the ligaments tend to stretch and thicken. This may cause instability between vertebrae, as well as result in pressure on the spinal cord and nerve roots
• Spinal cord - Myelopathy (malfunction of the spinal cord) occurs due to compression of the spinal cord. Motion of the spine rubbing on the cord may also contribute to the myelopathy. Furthermore compression of the spinal cord may lead to a compromise of the blood vessels feeding the spinal cord, which further aggravates the myelopathy.

The Operative Procedure

• There are two procedures for decompressing the cervical spine. The surgeon will decide which is best for your situation.

1. Cervical laminectomy in which the lamina and spinous processes are removed to expose the dura covering the spinal cord (shown above)
2. Anterior decompression of the cord

• For a cervical laminectomy, the patient is positioned on the operating table with the head and neck in a neutral position since undue flexion or extension of the neck may cause pressure on the spinal cord
• Because placing a tube in the airway (endotracheal tube) may result in excessive extension of the neck, the tube is frequently inserted with the patient awake and mildly sedated.
• Steroid medication may be given to help in protecting the spinal cord
• In some instances the surgeon may monitor the ability of the spinal cord to transmit impulses (somatosensory evoked potentials). Such monitoring is more often used when the laminectomy is used for the removal of a spinal cord tumor
• The patient is placed prone (face down) on the operating table with the head held firmly by a special headrest.
• After the skin is cleaned and disinfected and sterilely draped, an incision is made in the skin of the back of the neck
• The muscles are elevated and the spinous processes, lamina and facets are exposed
• The laminae and spinous processes are removed with specialized drills and other equipment, taking great care to protect the underlying spinal cord.

Relative contraindications for cervical laminectomy:

• Elderly patient combined with osteoporosis
• Severe lung disease
• Severe heart disease
• Loss of the normal curve of the cervical spine
• Instability because of inadequate structures in the anterior parts of the cervical spine 

Complications: These complications and others are always possible, but fortunately are very uncommon.

• Worsening of the neurologic condition such as increased paralysis or loss of sensation. It is always possible to injure the nerves and spinal cord, but this is very uncommon.
• Bleeding
• Forward bending of the cervical spine (kyphosis)
• Tear in the dura (covering the spinal cord), which would need repair at the time of surgery.
• Injury to nerve roots
• Leaking of the fluid surrounding the cord (cerebrospinal fluid) through to the skin
• Injury to the nerves going to the arms (brachial plexus)
• Infection
• Postoperative instability of the spine, requiring a fusion at a second operation.

Please read "Risks and Possible Complications"

What to expect after surgery:

• A cervical collar is needed only if a fusion was performed. However, you may want to wear a soft collar for comfort.
• Even though the muscles are spread apart and not cut, they will be painful. For some patients this can be mild discomfort and for others it can require regular use of narcotics. This will pass, but may take several weeks.
• You will most likely require removal of sutures or clips after 7-10 days.
• Use the medication when you need it. But, use the ice machine several times a day. This will definitely lesson your neck pain and allow you to recover more quickly.
• Tingling sensations or numbness are often the last symptoms to disappear. Numbness that lingers in parts of the arm or fingers usually is no cause for worry and should gradually go away, if the nerve or spinal cord is capable of recovery.
• Gradually increase the amount of walking you do each day. Since it may at first be painful, try making short trips. Begin with a trip to the bathroom, then to the door, and later out into the corridor. Sitting and standing also require a gradual pace. If discomfort occurs, change positions and rest frequently.
• Unless instructed otherwise, you may take a shower the day after surgery. Carefully dry the incision afterwards, and keep the incision as dry as possible all other times.
• You may feel discouraged and tired for several days after surgery. These feelings may be your body's natural reaction to the cutback of extra hormones put out to handle the stress of surgery. Although emotional let-down is not uncommon, it must not be allowed to get in the way of the positive attitude essential to your recovery and the return to normal activity.
• Daily walking is the best exercise for mind and body during recovery. Try to increase your distance a little each day, setting a pace that avoids fatigue or severe pain. Climb stairs when you feel able. You must get as much exercise as you can, without increasing your pain
• Sexual relations may be resumed during the recovery period, but positions that strain the neck or cause pain should be avoided.
• "Listen" to your body. Discomfort is normal while you gradually return to normal activity, but pain is a signal to stop what you are doing and proceed more slowly.
• Drive a motor vehicle only after discussing this with the surgeon. Do not drive after taking pain medication.
• You should gradually use less pain medication while recovering at home. This can be accomplished by increasing the amount of time between taking pills, then by reducing the number taken each time. Some discomfort and pain in the neck and arm(s) can be expected until the inflammation and nerve sensitivity have ended. Heat, exercise, massage, and short rest periods will also help relieve pain.
• Physical therapy will be prescribed, if appropriate, as soon as possible.

Office Hours

Our office hours are Monday through Friday from 8:30 AM to 4:30 PM. We ask that you call between these hours with your questions, concerns, prescription refill requests, etc. As a surgeon, I am frequently in the operating room and therefore unable to be available during all office hours.

Prescriptions

All prescription refills and changes must be requested during office hours. We advise patients to monitor their need for refills so that refill requests can be made during your office visit.

Emergencies

We understand that emergencies arise. If you feel that it is absolutely necessary to speak with your doctor during non-office hours, our answering service is available, by simply dialing our office telephone number listed below. We ask that this service be reserved only for emergencies.