What is Cervical Laminectomy and Fusion?
Posterior cervical laminectomy and fusion is a surgical procedure used to relieve compression of the cervical spine cord in the neck and to maintain or correct spinal alignment. This procedure is most frequently performed for a condition called cervical myelopathy, which causes progressive difficulty with hand function and dexterity, and difficulty with walking balance.
It can also be associated with pain, numbness, or weakness in the arms or legs or both. It is also sometimes performed for cervical radiculopathy or also for pseudarthrosis after a previous anterior cervical discectomy and fusion, when a previous spinal fusion from the front of the neck failed to successfully fuse or heal.
Cervical Laminectomy and Fusion Procedure
Cervical laminectomy and fusion is performed under general anesthesia with the patient positioned on their belly. After sterile preparation of the skin and placing sterile drapes, an incision is made on the back of the neck over the affected levels.
After a meticulous exposure of the cervical spine, screws are placed into the cervical spine into portions of the bone called the lateral masses or the pedicles. Next if a laminectomy needs to be performed to relieve pressure on the spinal cord, this is accomplished using a high speed burr to carefully remove the lamina. A foraminotomy may also be performed, which involves enlarging the channels through which the spinal nerves travel to the arms.
Next rods are placed to connect the screws together in appropriate spinal alignment, and bone graft is laid onto the remaining bony portions of the spine to allow the spine to eventually heal together into one continuous bone. X-rays are obtained to confirm good position of the instrumentation and appropriate spinal alignment, and then the incision is closed.
Posterior Cervical Laminectomy and Fusion Recovery Time
After cervical laminectomy and fusion, patients can typically go home the next day after surgery, or occasionally after two days. Surgery through the back of the neck can be fairly painful in the first 1-2 weeks but this can be controlled using prescribed pain medication and frequent icing. The neck pain will gradually subside. A hard cervical collar is sometimes recommended after surgery depending on the exact procedure performed and patient specific factors. If a collar is recommended, it should be worn at all times including sleep except to eat and shower for the first 6 weeks after surgery.
Walking is recommended for exercise and should be started immediately after surgery. After going home from the hospital, patients should start with two 5 minute walks per day and gradually increase this to two 15-20 minute walks per day. Low impact exercise such as walking, stationary bike, or an elliptical machine will increase blood flow to the healing muscles and to the healing spinal fusion and speed up recovery.
Patients typically can transition out of the hard cervical collar at 6 weeks after surgery. Heavy lifting > 15lbs or overhead activities should be restricted until 3 months after surgery. Patients will typically notice an improvement in their arm pain immediately after surgery but the recovery of myelopathy symptoms (numbness, weakness, problems with hand dexterity and balance) can be more prolonged and take weeks to months.
The full extent of spinal cord recovery will not be known until 1 year after surgery. Myelopathy symptoms typically do not fully recover completely due to the limited healing potential of the spinal cord, but surgery will stop the worsening of myelopathy symptoms.
Post-operative visits are recommended at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years after cervical laminectomy and fusion surgery.
Laminoplasty vs Fusion
Cervical laminectomy and fusion is recommended for patients with multilevel spinal cord compression and signs of cervical instability or malalignment (kyphosis). Other procedures which may be recommended to decompress the spinal cord or nerves to relieve myelopathy symptoms or radiculopathy include an anterior cervical discectomy and fusion (ACDF) or a laminoplasty.
ACDF surgery is typically recommended for patients with 1 or 2 level disease while cervical laminectomy and fusion is often recommended for patients with 3 or more involved levels. Sometimes the spinal cord can be decompressed without having to perform a fusion using a procedure called posterior cervical laminoplasty, which involves reshaping the roof of the spinal canal (lamina).
The optimal procedure for any given patient involves a complex decision making process which depends on the patient’s anatomy, general medical health, and the patient’s specific goals.
Risks of Cervical Laminectomy and Fusion
While all spinal procedures involve risks, the benefits typically greatly outweigh the risks if cervical laminectomy and fusion is recommended. The risks of cervical laminectomy and fusion include:
Neck pain. The surgery itself is painful and patients typically require strong pain medication for the first 1 to 2 weeks after surgery. Regular exercise and frequent icing of the back of the neck also helps with neck pain after surgery. The goal of the operation is not to treat neck pain but rather to treat symptoms of myelopathy (spinal cord dysfunction) and radiculopathy (arm pain). The relief of neck pain symptoms after cervical laminectomy and fusion is unreliable and many patients still will have some neck pain after recovering from surgery.
Pseudarthrosis. This means that the spinal fusion itself did not heal, and that the bones did not properly mend together to become one bone. Patients that smoke cigarettes or have other chronic medical conditions (diabetes) are at higher risk for pseudarthrosis. If this happens, it can result in failure of the instrumentation with the screws breaking or loosening, or the rods breaking. Sometimes, this requires additional surgery to repair.
Adjacent level disease. When a spinal fusion is performed, there is additional stress placed on the levels above and below the fusion. If this occurs and causes persistent symptoms that don’t respond to conservative treatment, additional surgery may be required.
Persistent arm pain, numbness, tingling, or myelopathy symptoms. The spinal cord has a limited capacity to heal; therefore, even after surgery to relieve pressure on the spinal cord, myelopathy symptoms might persist. However, surgery will stop the symptoms from worsening at the very least and most patients get substantial improvement in their spinal cord function after surgery.
Infection. The risk of infection after posterior cervical surgery through the back of the neck is higher than for operations through the front of the neck, although the rate of infection is still fairly low (2-3%).
If you have more questions or would like to schedule an appointment with Dr. Nemani to see if you are a candidate for a cervical laminectomy and fusion surgery, please call 919-781-5600 or book an appointment online.