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Cervical Laminectomy and Fusion Surgery

What does “Cervical Laminectomy and Fusion” mean?

  1. Cervical: the spine in the neck area
  2. Laminectomy: removing the bone shelf (lamina) on the back of the spine
  3. Fusion: to mend bones together

Altogether, “Cervical Laminectomy and Fusion” means removing the bone shelf of the back of the neck to relieve compression of the spinal cord. The bones are then mended together.

What is a Cervical Laminectomy and Fusion?

A cervical laminectomy and fusion is a surgery done from the back of the neck (cervical spine) as opposed to other surgeries, (ACDF, Cervical Corpectomy, C-ADR) which are done from the front of the neck. The surgeries done through the front of the neck take advantage of the fact that the structures in the front of the neck are relatively soft and mobile. As opposed to that, the structures on the back of the neck are firmer and more difficult to work on. For instance, the muscles in the back of our neck are very tight and strong.

During a cervical laminectomy and fusion surgery, these muscles are moved off to the side so the bone underneath (lamina) can be seen. The lamina is removed to be able to give more room to the spinal cord and spinal nerves. After removing this bone, the spine is often fused at this segment. This is done out of fear that the spine could be unstable after the lamina bone has been removed. The fusion requires that metal screws and rods are placed into the vertebra above and below the laminectomy. Bone is placed next to the screws and rods to help form a bone fusion over time.

Why is a Cervical Laminectomy and Fusion surgery done?

Here are the goals of a cervical laminectomy and fusion:

  1. To free up the spinal cord by removing bone (lamina) on the back of the neck. It is typically done because doing the surgery from the front of the neck would not necessarily be able to accomplish the same goal of freeing up the spinal cord and spinal nerves.
  2. To provide stability for the spine following the removal of the lamina bone. This is typically done by fusing the bones of the back of the spine.

How is the Cervical Laminectomy and Fusion surgery actually done?

Here are some of the steps of how the surgery is performed:

  1. An intravenous catheter is placed and antibiotics are given before surgery.
  2. This surgery is performed in an Operating Room.
  3. The patient is placed under General Anesthesia while lying on their back (supine)
  4. The patient is then carefully placed on their stomach (prone) on the operating table.
  5. The head and neck are carefully positioned to make the approach for surgery as good as possible.
  6. The back of the neck is now cleaned with a surgical antiseptic and plastic covers (drapes) are placed around the area where the surgery will take place.
  7. The surgeon then makes the initial cut (incision) in the center of the spine.
  8. The softer tissues (fat, fascia) are then divided with a cautery until the tips of the spinous processes (tips of the spine) are seen.
  9. The muscle attachments to the back of the vertebra are then carefully separated from the bone and the muscles pulled to the sides.
  10. Often X-Rays are taken to make sure the surgeon knows this is the correct level in the spine.
  11. The spinous processes are now removed.
  12. The lamina is now clearly visible and often thinned using a burr (similar to dentist’s drill).
  13. Once the lamina is quite thin, it is carefully removed with very delicate, small instruments until the spinal cord and sometimes spinal nerves can be seen.
  14. At this point, small titanium screws are place into the bone on the side of the vertebra (lateral mass) with the help of X-Ray machines. Sometimes the spinal cord and spinal nerves are monitored with a nerve monitor (neuromonitoring) to make sure no harm comes to them.
  15. Once the screws are placed, a small titanium rod is chosen to connect them. This provides stability to the area where the lamina bone was removed.
  16. The bones in the area where the screws and rods are located are now intentionally prepared with a burr to make it more likely for the bones to fuse.
  17. The bones which were previously removed from the spine is now made into smaller pieces and placed over the area which was prepared. Sometimes additional materials are placed into this area to make a fusion more likely.
  18. The main part of the surgery is now complete. Additional X-Rays are often taken throughout. A surgical drainage tube is sometimes used.
  19. The retractors are removed and the muscles allowed to fall back over the area where the surgery took place.
  20. The muscles are usually stitched (sutured) back together.
  21. The skin is closed, often with small surgical staples.
  22. A bandage (dressing) is placed over the wound.
  23. Often, a hard brace is put on the neck to protect the area from movement.
  24. The patients is carefully rolled back on their back (supine) and awoken from Anesthesia.
  25. The patient is then brought to the Recovery Room.
  26. Often more X-Rays are taken there.

How long does a Cervical Laminectomy and Fusion surgery like this take?

A cervical laminectomy and fusion can take from 2 to 4 hours to complete for one spinal level. More time would be needed for more spinal levels.

What is the recovery from a Cervical Laminectomy and Fusion like?

  1. The patient is admitted to the hospital for 1-3 days or more.
  2. A neck brace will often stay in place for much of the time in the hospital and often for 4-6 weeks or more after discharge.
  3. The surgeon will restrict the amount of motion in the neck. Typically, the movement in the neck is very limited at least for the initial few weeks.
  4. The patient is often discouraged from taking non-steroid anti-inflammatory medications which could interfere with the fusion.
  5. The patient is discouraged from smoking since it interferes with the fusion.
  6. The surgeon will evaluate the patient and take more X-Rays within a few weeks after surgery.
  7. The restrictions on movement are slowly lifted over time.
  8. The fusion can take 6 months to 1 year to fully develop. This does not mean that the patient will have pain or be very limited in their neck movement during this time.
  9. The symptoms (pain, numbness, weakness) may take weeks to months to reach the maximum level of improvement as the spinal nerves and spinal cord heal. Some of the symptoms from long-term spinal cord compression may remain.

What type of benefit can patients gain from a Cervical Laminectomy and Fusion surgery?

The main benefit is that the compression of the spinal cord and spinal nerves is now relieved. This can relieve symptoms of numbness, tingling and weakness in the legs.

Bowel, bladder and gait problems can be improved.

Depending on how long the spinal cord or nerves were compressed for and how severe the compression was, the recovery can be complete or partial.