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Cervical Laminectomy

What is a Cervical Laminectomy?

A cervical laminectomy is a surgical procedure performed on the cervical (neck) region of the spine to help relieve the disabling pressure of stenosis. Spinal stenosis is the gradual narrowing of the spinal canal, usually caused by arthritis, bone spurs, or the general wear and tear on the spine that occurs over time. A cervical laminectomy creates more space in the canal for the spinal cord and nerve roots, releasing the pressure and eliminating discomfort and numbness. 

During a cervical laminectomy, a small incision is made on the back of the neck to expose the vertebrae. The surgeon uses a high-speed burr, or rotary drill, to cut out a rectangular trough of bone from the rear of the vertebrae. The bone is carefully removed, which opens up the spinal canal and relieves pressure from the spinal cord and nerve roots. The surgeon then inspects the spinal canal and foramen (the opening through which the nerve roots exit) for bone spurs. Any spurs found behind the spinal cord and nerve roots are cleared away, the spinal cord is adequately decompressed, and the incision is closed.

Who is a Candidate for a Cervical Laminectomy?

Frequent pain and/or numbness in the neck or down the arms are often an indication of spinal stenosis. However, other factors can cause the spinal canal to narrow. Bony growths (spurs) can constrict the pathways through which the nerves must travel. In addition, some people are born with a narrow spinal canal that becomes symptomatic as they age.

The narrowing of the spinal canal may eventually cause pressure on the nerves and nerve roots that emerge from the spinal column. This irritation can result in pain and numbness, particularly after sitting or standing for extended lengths of time. A cervical laminectomy may be recommended in order to make more room for the nerves or nerve roots.

What are the Alternatives to a Cervical Laminectomy?

Surgery is usually the last option considered. If your symptoms are mild, you may not require any treatment at all. Other conservative treatments such as physical therapy, medications, and steroid injections may relieve symptoms for a time; however, they usually do not permanently change the underlying cause of the problem—the narrowing of the spinal canal. In some cases, a cervical laminectomy may be the only solution to remove irritation and create more space for the nerves.

How are Back & Neck Problems Evaluated?

Your doctor will use a number of approaches to evaluate and diagnose neck problems such as a herniated disc. These include:

A Detailed History – Your role in providing a detailed history is very important. Your doctor will need to know where and when it hurts, if there was a recent injury or fall, and a description of the pain. Are there positions or activities that make it feel worse? What makes it feel better? All of these details can help your doctor pinpoint the problem.

A Physical Exam – Once your history is given, a thorough exam by a spine expert is another important step in getting a good diagnosis.

Diagnostic Imaging – Xrays can show the structure and alignment of the vertebrae, as well as the presence and size of bone spurs or other bony abnormalities.

CT or “computerized tomography” – This is a special kind of xray machine. Rather than a single xray, a CT scanner sends out a number of beams at different angles. These images are then read by a computer, producing detailed cross-sections or “slices” that can show the shape and size of the spinal canal and the surrounding structures.

MRI or “magnetic resonance imaging” – MRI is probably the most utilized study for disc evaluation. MRI uses a powerful magnet and radio waves. The images produced are very helpful in visualizing the soft tissues such as the spinal cord, as well as the discs and nerve roots.

Bone Scans – These are useful in revealing certain abnormalities such as infections, fractures, tumors and arthritis. Because bone scans are unable to differentiate between these problems, they are usually performed in conjunction with other diagnostic tests.

How Long is the Hospital Stay?

The time spent in the hospital after a cervical laminectomy depends on several factors, including your overall health and the extent of your particular surgery. Some people may be able to return home the same day while others may spend one to two days in the hospital.

How Long Will it Take to Recover?

Recovery time after a cervical laminectomy varies depending on your particular situation, the number of levels involved, and your general health. The key to a successful recovery is maintaining a positive attitude. You will be able to take short walks while in the hospital, and you should gradually increase the distance and frequency of your walks once at home. A cervical collar may be required for a brief period after your cervical laminectomy. Your doctor will give you specific instructions on activity levels, including when you can resume driving and return to work.

Frequently Asked Questions (FAQs)

What is wrong with my neck?

You have a “pinched nerve.” This can be produced by a ruptured disc or by bone spurs. Discs are rubbery shock absorbers between the vertebrae, and are close to the nerves which travel down to the arms. If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the nerve and causing arm pain, numbness, or weakness. Bone spurs, usually the result of arthritis, can also put pressure on nerves. Occasionally, pressure from bone spurs or a ruptured disc may affect the spinal cord and cause other abnormalities in the arms, legs or lower parts of the body.

What is required to fix the problem?

An incision is made in the posterior part of the neck. Muscles supporting the spine are pushed aside temporarily, and bone is removed/moved to open the spinal canal. The nervous structures are protected, while the nerve/spinal cord are freed of pressure from the discs and/or bone spur. If bone spurs and arthritis are the cause of your problem, you may require a bigger incision and more bone may have to be removed. In the case of laminectomy most of the time a fusion must also be performed.

What is spinal fusion? When is this operation necessary?

A fusion is the formation of a bony bridge between at least two bones, in this case two vertebrae in your spine. The vertebrae are the blocks of bone which make up the spinal column, much like building blocks stacked on top of each other to make a tower. Normally each vertebrae moves within certain limits in relationship to its neighbors. In spinal disease, this movement may become abnormal and/or painful, or the vertebrae may become unstable and misaligned, putting pressure on the spinal nerves and/or spinal cord. In cases like this, surgeons try to stabilize the vertebrae using pieces of bone, which we call bone graft. The bone graft may be obtained either from the patient himself, usually from the pelvis, or from a bone bank. There are advantages and disadvantages to either source. The bone graft is laid between the vertebrae. The bone graft has to heal and unite to the adjacent bones before the fusion becomes solid. Spine surgeons often use rods to protect the bone graft and immobilize this area during the healing period, attaching them to the spine using screws.

In most cases, the major indication for spine surgery is pain. Weakness, numbness, clumsiness, and gait instability may also be an indication for surgery. Often nonsurgical measures can control the pain satisfactorily. If the pain persists and interferes with daily activities or if other neurological problems develop, then surgery may be necessary to relieve the problem. In most cases, the patient makes the final decision about surgery because of pain. If neurological damage is occurring, your doctors may strongly recommend that you proceed with the operation.

Who performs this surgery? When is this operation necessary?

Both orthopedic surgeons and neurosurgeons are trained in spinal surgery and both specialists may perform this surgery. It is important that your surgeon specialize in this type of procedure. In most cases, the major indication for spine surgery is pain. Weakness, numbness, clumsiness, and gait instability may also be an indication for surgery. Often nonsurgical measures can control the pain satisfactorily. If the pain persists and interferes with daily activities or if other neurological problems develop, then surgery may be necessary to relieve the problem. In most cases, the patient makes the final decision about surgery because of pain. If neurological damage is occurring, your doctors may strongly recommend that you proceed with the operation.

How long will I be in the hospital? When can I go back to work?

Most patients stay 2-3 days. Complications may require longer stays.

Going back to work depends on the type of work you do. If a brace is required, you will not be able to drive until you no longer need the brace. For sedentary jobs, work may resume when you feel comfortable and can get to work. For jobs which require more strenuous physical exertion, a longer healing time may be required. Your surgeon will discuss this with you individually.

Will I need a blood transfusion? Will I need to wear a neck brace?

Some blood loss is expected with this operation, but the need for transfusions is rare.

Most patients will wear some type of neck brace after this surgery. The type of brace and length of time you need to wear the brace will be determined by your surgeon.

What can I do after surgery? What shouldn't I do after surgery?

Please refer to the Cervical Fusion Discharge Instructions for details. You should try to walk and take care of yourself as much as you are able to. You should try to exercise each day. You may perform other low-impact activities not requiring lifting or neck movement as allowed by your brace. If a brace is not required, you may drive when allowed by your surgeon.

You should avoid lifting heavy objects, avoid all overhead lifting. Avoid twisting, repetitive bending and tilting your head back to look overhead are also stressful to the neck. If you are a smoker, you definitely should not smoke until your fusion is completely solid. Smoking interferes with bone healing and fusion.

Will my neck be normal after surgery? What are my chances of being relieved of my pain?

Even if you have excellent relief of pain, your neck will not be completely normal. However, most people can resume almost all of their normal activities after disc surgery. People who do heavy work generally take longer to recover and may not be able to do everything they could do before their injury.

Most patients get relief from their nerve symptoms or arm pain. Neck and shoulder pain are less predictably relieved by surgery. Up to 15 percent of patients may have some neck and shoulder aching after surgery; this percentage may be higher in patients who have a substantial amount of neck and shoulder pain before surgery. Other conditions such as fibromyalgia may also produce continued pain even after successful surgery.

Could I be paralyzed? What other risks are there?

The chances of neurological injury are very low, and the possibility of catastrophic injury such as paralysis, is highly unlikely, though not impossible. Injury to a nerve root with isolated numbness and/or weakness in the arm is possible.

There are general risks with any type of surgery. These include, but are not limited to, the possibility of wound infection, uncontrollable bleeding, collection of blood clots in the wound or in the veins of the leg, dural tear, pulmonary embolism (movement of a blood clot to the lung), heart attack, stroke, death, recurrent/persistent symptoms and failure of fusion. The chances of any of these events happening, particularly to a generally healthy patient, are low.

Could this ever happen to me again? Should I avoid vigorous physical activity?

Unfortunately, yes. The underlying problem that led to surgery cannot be cured. (arthritis, bone spur formation, disc degeneration). These processes may continue leading to possible recurrence in the future. Adjacent discs may be or may become abnormal too, and could cause symptoms in the future.

Exercise is good for you. You should get some sort of low-impact aerobic exercise at least 3 times a week. Walking either outside or on a treadmill and using an exercise bike are all examples of the type of exercise which is appropriate for spine patients.

Contact Us

Make an appointment with our Spine Care Coordinator to learn more about our patient-centered process for back surgery or to schedule a tour.

Dave Smith, Spine Care Coordinator
815.748.2968

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