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Cervical Laminotomy and Foraminotomy

What does “Cervical Laminotomy and Foraminotomy” mean?

  1. Cervical: spine of the neck area
  2. Laminotomy: removal of a piece of the lamina bone of the back of the neck
  3. Foraminotomy: removing some bone pieces to make the hole for the spinal nerve larger

Altogether, “Cervical Laminotomy and Foraminotomy” means removing a piece of lamina bone from the back of the neck and making more room around the spinal nerves.

What is a Cervical Laminotomy and Foraminotomy?

A Cervical Laminotomy and Foraminotomy is a surgery done from the back of the neck. A small piece of the lamina bone shelf on the back of the neck is removed so that the spinal nerve can be seen. At this point, other small bone pieces are removed from around the hole (foramen) through which the spinal nerve travels as it leaves from the spine towards the arm.

Why is a Cervical Laminotomy and Foraminotomy done?

This surgery is done to free up pressure on a spinal nerve. Often the pressure develops because of bone spurring or a disc herniation. Once the pressure on the nerve is removed, the nerve can heal and the pain from the nerve compression can improve.

Here are some of the steps of how the surgery is actually done:

  1. An intravenous catheter (IV) is started and antibiotic is given before surgery.
  2. This surgery is done 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 off to the sides with retractors (metal devices to help see deeper structures).
  10. Often X-Rays are taken to make sure the surgeon knows this is the correct level in the spine.
  11. The lamina is now clearly visible and often thinned using a burr (similar to dentist’s drill).
  12. Once the lamina is quite thin, it is carefully removed with very delicate, small instruments until the spinal nerve can be seen.
  13. The nerve is carefully inspected and any further bone or disc material is removed until it is completely freed up.
  14. The main part of the surgery is now complete.
  15. The retractors are removed and the muscles allowed to move back over the area where the surgery took place.
  16. The muscles are usually stitched (sutured) back together.
  17. The skin is closed, often with small surgical staples.
  18. A bandage (dressing) is placed over the wound.
  19. Often, a brace is put on the neck to protect the area from movement.
  20. The patients is carefully rolled back on their back (supine) and awoken from Anesthesia.
  21. The patient is then brought to the Recovery Room.

How long does a surgery like this take?

A Cervical Laminotomy and Foraminotomy often takes 1 – 3 hours to complete for a single spinal level.

What is the recovery from a Cervical Laminotomy and Foraminotomy like?

  1. The patient is admitted to the hospital usually just overnight.
  2. A neck brace will often stay in place for a short period of time.
  3. The surgeon may restrict the amount of motion in the neck for a short period of time.
  4. The surgeon will evaluate the patient and take more X-Rays within a few weeks after surgery.
  5. The restrictions on movement are lifted as healing occurs.
  6. The patient is often evaluated by the surgeon within several weeks. The wound will typically heal over 2-4 weeks.

The symptoms (pain, numbness, weakness) from the spinal nerve inflammation often improve quickly, but could take several months to reach the maximum level of improvement as the nerve heals.

What type of benefit could patients gain from a Cervical Laminotomy and Foraminotomy?

The symptoms from nerve compression such as tingling, numbness and pain in the arm often improve quickly. However it may take weeks to months for the maximum improvement to take place. Depending on how long and how severe the nerve compression was, the recovery can be partial or complete.