Posterior cervical laminectomy and fusion is an operative procedure to relieve pressure or compression on the nerve structures due to herniated disc, spinal stenosis or spondylosis. It is often performed for multilevel spinal cord compression from cervical spinal stenosis to decompress the spinal cord and nerve roots in the cervical region (neck region) of the spine.
Cervical stenosis refers to narrowing of the spinal canal in the neck region that compresses the spinal structures. The compression or pressure on the spinal structures results in neck pain, tingling sensation in the arms and/or legs, lack of coordination, and bowel and bladder problems. Disc degeneration, bulging or herniated disc, and spondylosis are the other spinal conditions that compress the spinal cord and nerve roots. Occasionally, there may be multiple disc bulges at various levels and the ligaments may bind to the spinal canal, causing spinal stenosis.
In cervical laminectomy, the lamina and spinous process are removed to create more room for the spinal cord and take the pressure off. Perhaps in patients with severe stenosis, laminectomy at three or more segments and a posterior longitudinal ligament (OPLL) resection for decompression are required. In such cases, posterior approach is preferred over anterior approach as it is technically easier to perform. Further, with multilevel laminectomy, there is a post-operative risk of developing instability that may lead to pain and deformity. To prevent this, usually a posterior fusion is also performed together with the multilevel posterior cervical laminectomy. Fusion at three or more levels from the front side can be difficult. Therefore, the procedure will be accompanied by a posterior cervical fusion to support the vertebrae with a bone graft.
Procedure
In posterior cervical laminectomy, a 3-4-inch-long incision is made in the midline of the back of the neck. After the muscles are elevated off the lamina (roof), the lamina along with the spinous process is removed as one piece with a high-speed burr creating more space for the spinal cord. Usually, local autograft bone harvested from the patient’s neck or bone from the iliac crest is then inserted into the empty space between the affected vertebrae to stimulate new bone growth. Instrumentation such as rods and screws are also placed into the spine to hold the vertebrae together during the healing process.
Risks and Complications
All major surgical procedures are associated with some risks. The potential risks of multilevel posterior cervical laminectomy and fusion include infection, bleeding, risks of anesthesia, nerve injury and fusion failure. The results of the surgery may be variable in some people with more extensive disease. Generally, most patients find improvement in their hand function and walking capabilities after the surgery.
