What structures make up the cervical spine?
What is a cervical laminectomy?
A cervical laminectomy is a common operation performed on the cervical spine through a posterior approach (through the back of the neck) whereby part of the bone of the vertebrae called the lamina are removed to decompress the spinal cord and/or nerve root(s).
In some cases, small bone screws are also implanted in the posterior aspect of the neck to stabilise the cervical spine. This is called a lateral mass fusion.
Why is a cervical laminectomy performed?
The most common indications for a cervical laminectomy are:
Spinal cord compression
Nerve root compression
This is a clinical condition usually due to compression of a nerve root. The nerve root is the start of a nerve as it exits from the spinal cord and spinal canal. It usually will join with other nerve roots outside of the spinal canal to form various peripheral nerves. Nerve roots normally supply sensation to an area of the body as well as supply various muscles to make them move. Radiculopathy is most commonly painful and the area in which the patient experiences pain will often indicate the nerve involved. In addition, there is often numbness and paraesthesia. Paraesthesia is commonly referred to as pins and needles. Again, these may indicate the nerve root that is affected. Finally, there may be weakness of a muscle or of a movement.
Nerve root compression causing radiculopathy is most commonly due to a disc protrusion or bony spurs (osteophytes). There are many other reasons for radiculopathy such as a synovial cyst for example.
In some instances, a cervical laminectomy may be adapted to decompress one or more nerve roots at the same time. A cervical laminectomy is not normally performed for nerve root compression alone, but rather when there is a combination of spinal cord and nerve root compression.
Related conditions to cervical laminectomy
What is a cervical laminectomy?
Cervical laminectomy is an operation performed under a general anaesthesia. The patient is positioned face down on a special operating table. An incision is made in the midline of the back of the neck and the muscles dissected from each side of the back of the spine so as to expose the lamina. The level is then checked, usually with an x-ray.
Using a special drill, the bone is carefully removed so as to decompress the spinal cord. Ligaments at the back of the spine, between the bones, is also removed to ensure the spinal cord is well decompressed.
If a lateral mass fusion is also performed, then bone screws are placed into an area of bone on the side of each of the vertebrae. This area of bone is called the lateral mass. The screws are then joined together with a small rod on each side. Bone graft is then packed around the screws on each side.
The wound is irrigated and checked for bleeding. A drain is left in the wound as a precaution. The wound is then sutured with self-dissolving sutures and a dressing applied. The operation normally takes 1-2 hours depending on the patient and the pathology.
The patient is then woken from the anaesthetic and checked for neurological function. The patient is then observed overnight in the high dependency / intensive care unit before being transferred to the ward. The drain is usually removed on the day after surgery.
What are the expectations after surgery?
The expectations for surgery will depend on the indication for surgery. However, almost all patients will have some common experiences. Patients are normally able to communicate and talk with their family within an hour or so of their surgery. The throat is often sore and some patients may experience discomfort on swallowing. This generally resolves within a few days, but occasionally will take longer. Patients are normally able to eat and drink.
The physiotherapists will help with exercises to assist in preventing neck stiffness. Patients are usually mobilised the day after surgery and would spend about 2 days in hospital. Some patients will leave hospital within 2 days while others will stay for up to one week depending on their speed of recovery. In most cases a cervical collar is not used after surgery.
Patients with a myelopathy have variable rates of recovery. The main reason for surgery in these patients is to stop further deterioration. However, around 50% will experience some improvement while 40% will remain unchanged and 10% will continue to deteriorate. Patients that have milder symptoms to begin with normally have a better rate of recovery than those with very severe symptoms. The reason for this is that once the spinal cord is damaged it has limited capacity for recovery.
Pain is the most common symptom of radiculopathy and, in most cases, is the first symptom to improve; often immediately after the surgery. Pins and needles may take longer but tend to improve quickly. Numbness takes the longest period to recover, perhaps even over 12 months and some patients may not experience full recovery of numbness. Weakness has variable recovery depending on severity and duration before surgery. Some patients will experience recovery immediately while others may have persistent weakness despite the surgery. Normally physiotherapy is required to treat weakness. Overall, about 90% of patients will experience significant improvement in pre-operative symptoms while a further 10% will not improve as much as is hoped and 1-2% percentage will be worse off in relation pain or some other problem. No guarantees can be given in relation to the surgery.
What are the risks of a cervical laminectomy?
All surgery caries risk. There are risks common to all surgeries such as infection, bleeding, deep vein thrombosis (DVT), pulmonary embolism and those associated with a general anaesthetic.
Surgery around the spinal cord and nerve roots carries a small risk of neurological injury that may be temporary or permanent. This could range from at the worst, quadriplegia (inability to move the arms and legs), paraplegia, or weakness/ numbness involving part of an arm or leg. These risks are very rare.
A specific risk of a cervical laminectomy is however C5 radiculopathy. This is a well-recognised issue that may arise several days after surgery with pain and weakness involving the shoulder. It is thought to be due to a change in the position of the spinal cord following decompression which results in traction on the nerve root. It may occur even with what is a routine straight-forward procedure. It is most common temporary and resolves over weeks to months.
If a lateral mass fusion is performed, there is a risk of the bones not healing together as one, i.e., non-union / failure of fusion. This may result in neck pain and revision surgery. There is a risk of adjacent segment disease. As the spine is fused at the level(s) of the pathology, more stress is placed across the levels above and below the level of the fusion. This may accelerate changes at those levels and cause similar problems, sometimes requiring surgery.
This is not an exhaustive list of potential complications but this information provides an overview of the more common complications that patients may be exposed to.
How long is the hospital stay and what happens during that time?
The hospital stay is normally around 4 days in total but varies depending on the patient and their underlying condition. The day after the surgery the wound drain is removed and plain x-rays of the neck are obtained. During the hospital stay the patient receives daily physiotherapy. Patients will receive prophylactic subcutaneous heparin injections and are required to wear stockings to prevent DVTs.
After surgery, there is normally some discomfort and analgesia is provided. However, the amount of analgesia is required is usually small. Constipation is a common complaint after surgery and is usually due to analgesics. Patients should inform staff if this becomes an issue.
The wound is normally cleaned and the dressing changed each day. After discharge no dressing is required. You may shower and then pat the wound dry with a clean towel afterwards. While the wound may get wet, do not soak it in the bath or in a pool for at least 2 weeks after the surgery. Do not rub the wound. If there are any concerns such as excessive redness, pain or ooze then you should have your GP review the wound as the first step.
What do I need to do at home after a cervical laminectomy?
After discharge, it is advisable to rest for 2 weeks which should consist of normal daily activities. One should not sit in the one position for too long such as at a computer for more than 20 minutes at a time. Once you feel more confident then activities such as driving can resume. Normally one can drive after 2-4 weeks from the date of surgery. A return to work depends on the work environment. Those with sedentary jobs can usually begin to go back to work after 2 weeks. Those with more physical jobs should wait at least 6 weeks but it should be discussed with Prof Owler.
When do I see Prof Owler in follow-up?
A post-operative appointment is normally arranged at 6 weeks post-surgery. The appointment is normally provided to the patient at the time of discharge from hospital. At that visit any concerns can be discussed and the wound will be checked.
What restrictions do I have after a cervical laminectomy?
There are few long-term restrictions after this surgery. Patients who undergo a cervical laminectomy are usually advised to avoid body contact sports such as rugby league and union as well as to avoid any activities where there may be undue strain on the neck.
For the first 2 weeks patients should not lift any significant weights. This can gradually be increased by 5 Kg every 2 weeks. By the post-operative visit at the 6 week point after surgery, patients should have been lifting < 10Kg. After this the limit, can be increased. There is a general lifting limit of 20Kg for most people but this may need to be varied depending on the patient’s occupation.