Posterior cervical laminectomy and fusion may be performed to remove pressure (decompress) the spinal cord and nerve roots and stabilize the neck (fusion). Disc degeneration, bulging or herniated disc(s), osteoarthritis (spondylosis), and spinal stenosis are disorders that may compress the spinal cord and nerve roots. Compression or pinching of these neurologic structures may result in neck, shoulder, upper back, and arm pain. Other neurologic symptoms may include numbness, tingling, and weakness in the arms or hands. The goal of posterior cervical laminectomy and fusion is to decompress the spinal cord and nerve root(s), stabilize the neck, relieve symptoms, and enable the patient to return to regular activities of daily living.
Posterior = back
The surgical incision is made in the back of the neck.
Cervical = neck
The cervical levels are one region of the spine. There are seven vertebral bodies in the neck; numbered C1 (top) through C7 (bottom). The disc levels are also abbreviated. For example, C3-C4 refers to the intervertebral disc between the third and fourth cervical vertebral bodies (bones).
Laminectomy = to remove the lamina
The lamina is a thin plate of bone at the back of the neck that makes up the roof of the spine and helps to protect the spinal cord. During laminectomy, the bony plate is removed to allow Dr. Stieber access to the spinal cord and other nerve structures.
Fusion = to join or combine
Bone graft is inserted into the empty space between the upper and lower vertebral bodies. Instrumentation (rods and screws) is implanted to immobilize (stabilize) the neck. The body’s natural healing processes cause new bone to grow into and around the instrumentation, resulting in a spinal fusion.
Not every patient with a cervical degenerative disc problem, herniation or spinal stenosis requires spine surgery. Dr. Stieber may recommend posterior cervical laminectomy and fusion for the following reasons: if non-operative treatment fails to relieve symptoms, progressive worsening of neurologic symptoms or pain, spinal instability, and/or neurological problems. Numbness, loss of function, and weakness are examples of neurologic dysfunction. Loss of manual dexterity, difficulty with fine motor movements, and disruption of walking balance may be signs of myelopathy and signal dangerous compression of the spinal cord within the spine.
About Posterior Cervical Laminectomy and Fusion
Posterior cervical laminectomy and fusion are performed under general anesthesia. The neck is shaved, cleansed, and prepared for surgery. The patient is positioned face down (prone) on the operating table. The patient’s skull is held securely in position, and the neck is immobilized by means of a device made for this purpose. A special monitoring system checks the spinal cord and nerve function throughout the procedure to prevent injury. Fluoroscopy, a type of real-time X-ray, is used throughout the surgery to see the patient’s anatomy and guide instruments.
A skin incision is made in the middle of the back of the neck (a midline incision). Muscles and other soft tissues are moved away from the spine. Special surgical instruments are used to carefully remove the lamina and remove tissue and bone, compressing the spinal cord and nerve structures. The lamina and other bone removed may be prepared and used for bone graft. Rods, screws, and bone grafts are implanted to stabilize the neck and to facilitate fusion and healing.
Types of Bone Graft
- Autograft is the patient’s own bone. Autograft may be bone taken from the patient’s neck during laminectomy or in a separate procedure where bone is taken from the patient’s hip.
- Allograft is donor bone from a bone bank.
- Bone graft substitutes; there are of different types, some of which are synthetic (man-made) and available in different shapes.
One or more post-operative X-rays are taken to ensure the bone graft, rods, and screws are well-positioned. The wound is closed and bandaged.
After Surgery
After surgery, the patient is moved into the recovery area. In recovery, nurses and other members of the medical team closely monitor the patient’s vital signs – pulse, respiration, blood pressure, and pain. Some post-operative pain should be expected, and patients receive pain medication either through their IV (intravenous line) or by mouth.
- A post-operative cervical brace, collar or halo is prescribed to wear for a time period after surgery to help immobilize and support the neck while healing.
- A typical hospital stay is 2 to 3 days. Dr. Stieber discusses hospitalization with patients before their surgery date.
After Care at Home
Dr. Stieber provides posterior cervical laminectomy and fusion patients with information about what to expect and self-care after hospital discharge. This information includes instructions to control pain, medications, brace/collar/halo care, diet, managing constipation, bathing and incision care, activity restrictions, and surgical follow-up appointments. As always, Dr. Stieber and his staff welcome questions and ensure that all patient concerns are thoroughly addressed.