A cervical laminectomy is a surgical procedure that can effectively relieve compression of the spinal nerves and so reduce the pain of spinal stenosis. Cervical spinal stenosis is a condition that involves a narrowing of the spinal column in the neck area. It often produces pain, cramping, weakness or numbness in the neck, shoulders or arms. This condition can develop as a result of injury to, or deterioration of, the discs, joints or bones within the spinal canal. Because the vertebrae of the neck are more capable of movement than any other area of the spine and because they are not only responsible for protecting the spinal cord, but for supporting the skull, surgical repairs in this area are a delicate matter.
While many cases of spinal stenosis can be successfully treated through conservative methods such as rest, wearing a back brace, engaging in physical therapy, or taking nonsteroidal anti-inflammatory drugs, some patients do not respond to these measures. If the symptoms of spinal stenosis become progressively worse, a cervical laminectomy may become necessary.
The Cervical Laminectomy Procedure
In a cervical laminectomy procedure, a small section of bone that covers the back of the spinal cord, called the lamina, is removed. The removal of this portion of the bone and any nearby bone spurs relieves the pressure on the spinal cord.
A laminectomy of the cervical spine is performed through the upper back and neck while the patient is under general anesthesia. The surgeon makes an incision and carefully retracts the muscles and ligaments to obtain access to the spine. An imaging device such as an X-ray is typically used during the surgery to view the vertebral structures more precisely and pinpoint the problem area.
Depending on the extent of the damage, the lamina may be removed in portions or in its entirety on both sides of the spine. The surgeon will then assess the region, removing any calcified cartilage as well as the spinous processes, the sharp protrusions at the back of each vertebrae, if necessary. By removing the lamina, bone spurs and other debris, the compression of the spinal cord and spinal nerves is alleviated and symptoms improve.
If the bones within the cervical spine have been moving against each other, a spinal fusion procedure may be necessary to promote stability. This procedure can be performed at the same time the patient is undergoing the cervical laminectomy. The fusion involves inserting a bone graft into the space between the affected vertebrae in order to join them. The bone graft is harvested from another part of the patient's body or is received from a donor bank The surgeon will also attach titanium metal rods, plates and screws to the vertebrae to prevent movement of the bones during the fusion process.
Recovery from Cervical Laminectomy
A cervical laminectomy should relieve much or all of the pain and numbness in the arms and neck that stenosis sufferers experience. After the procedure, the patient typically remains in the hospital for a short stay and may be fitted with a neck brace for temporary support.
Soon afterward, most patients begin a physical therapy regimen to build up muscle strength and increase flexibility. Patients are advised to refrain from reaching, lifting, pushing or pulling for several weeks after the procedure. Usually, they can return to work in approximately 3 months. When a cervical laminectomy is accompanied by spinal fusion, recovery time may be somewhat longer.
Risks of Cervical Laminectomy
Cervical laminectomy is a spinal surgery procedure and as such, carries some risk. These risks include postsurgical infection, excessive bleeding, blood clot formation, nerve damage and adverse reaction to anesthesia.
At present there is some debate about whether to remove hardware that has been used in previous cervical surgeries. While clearly it is not a good idea to have unnecessary hardware remain inside a patient, removing the materials can cause complications, particularly since scar tissue will have grown around the surgical site. Recently, a new evaluative tool, known as electrodiagnostic functional assessment, has become available. This assessment method combines electromyography (EMG), functional capacity evaluation (FCE), and range of motion (ROM) measurement to provide important data so that an informed decision can be made about whether hardware removal is necessary in an individual case.