Cervical Laminoforaminotomy & Microdiscectomy
What are the structures of the cervical spine?
What is a cervical laminoforaminotomy and / or cervical microdiscectomy?
A cervical laminoforaminotomy is an operation performed from the posterior aspect of the neck through a small incision to decompress a nerve root as it exits the spine in the neck. While most commonly performed to decompress a single nerve, it can also be performed to decompress nerve roots at multiple levels through the same incision. The decompression is performed by drilling away a small area of bone, that is, part of the lamina and medial part of the facet joint, so as to expose the nerve and ensure that it has enough space to freely pass through its foramen.
If the nerve is compressed by a disc protrusion in or near the exit foramen, once the nerve is exposed by the laminoforaminotomy, the disc fragment may be removed as well, resulting in further decompression of the nerve root. This is called a cervical microdiscectomy.
Why is a cervical laminoforaminotomy and / or cervical microdiscectomy performed?
The most common indication for a cervical laminoforaminotomy is a cervical radiculopathy. 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.
Not all nerve root compression, which is often evident on CT or MRI scans, is symptomatic. We commonly see patients with nerve root compression on imaging who have no symptoms. This does not require surgery as we are interested only in making the patients better, and not their x-rays.
Related condition to cervical laminoforaminotomy & microdiscectomy
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 2-4 days in hospital. In most cases a cervical collar is not used after surgery.
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% percent 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 laminoforaminotomy and / or cervical microdiscectomy?
All surgery carries 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. These complications are unusual. The nerve root is at risk of injury which could result in weakness, numbness and/or pain in the distribution of that nerve. The surgery is near the spinal cord. Injury to the spinal cord could result in quadriplegia (inability to move the arms and legs), paraplegia, or weakness/ numbness involving part of an arm or leg.
Neck pain is common in the immediate post-operative period and normally settles. However, long term neck pain is a risk of surgery in this location.
It is unusual for disc protrusions to recur in the cervical spine however this is also a potential risk of this 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 2 days in total but varies depending on the patient and their underlying condition. 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.