Posterior Cervical Laminectomy & Fusion
Posterior – From the Back
Cervical – Neck
Laminectomy – Removal of part of the “roof” of the spinal canal
Fusion – the bones of the neck are connected via special screws to allow them to grow and move as one
What Are Some Of The Reasons I Might Need A Posterior Cervical Laminectomy And Fusion?
This surgery is usually recommended to address problems of:
- Herniated Nucleus Pulposus
- Bone Spurs
- Foraminal Stenosis
- The main reason for this surgery is pressure on a nerve going to the arm.
- Cervical cord compression causing myelopathy (weakness in arms and legs).
What Are Some Of The Symptoms I Might Experience?
You might experience all or some of the following in your arm and/or hand: pain, numbness, tingling, weakness.
How is the surgery done?
An incision is made at the back of the neck, and the muscles pulled to one side. The lamina (the “roof” of the spine) may be removed in order to decompress the spinal cord, or only the part of the lamina may be removed that is over the foramen where the nerve roots are being trapped. A foraminotomy, making more room for the nerve root, or a discectomy, removing protruding part of the disc or disc fragments, may be done to relieve pressure on a nerve. The muscles are released and the incision is closed. If a cervical fusion will be done, small screws will be inserted in the bones of the neck to prevent the bones from moving and provide an environment for the bones to grow as one. Small pieces of specially prepared cadaveric bone may be used to enhance the fusion process. A small drain may be left at the incision site for 1-2 days to remove excess fluid.
Risks For The Posterior Cervical Laminectomy And Fusion
There is a 90% satisfaction outcome from cervical laminectomies. Complications are rare, but you need to be advised that they can occur. Some possible complications are:
- Pain, numbness, and clumsiness could occur even if the surgery is correctly done.
- There could be impaired muscle function or paralysis which is temporary or permanent.
- Incontinence or impotence could occur. This refers to loss of bowel, bladder or sexual function.
- Unstable spine is a possibility. Sometimes, in order to resolve the problem, so much bone is removed that the spine is left with weakness or instability. If there is not enough bone left to provide the appropriate amount of stability, it might be necessary in the future to contemplate having a spinal fusion which is a more extensive surgical procedure to reconstruct the weakness in the bones.
- Recurrence or continuation of the condition that required the operation. There is a possibility that the disc that has been removed might rupture again. This occurs 5-10% of the time, although it can be many years later.
- Injury to major blood vessels. The area in front of the vertebral column is immediately adjacent to the major large arteries and veins that come from the heart to supply the organs in the lower part of the body. It is extremely rare, but it is possible for a surgical instrument to go beyond the annulus in the front part of the spine and injure one of these vessels. If that were to occur, we would be dealing with an internal hemorrhage situation and we would need to do an immediate operation from the front side to correct it.
- Leakage of spinal fluid requiring re-operation. The dura is the hard covering of the nerves and spinal cord. Underneath the dura is the spinal fluid surrounding the nerves. If a hole is accidentally placed into the dura then the spinal fluid could be allowed to exit this area. If that occurs while we are in surgery, then it is a fairly simple matter to place a stitch through the small tear and close the opening so that fluid can no longer exit. However, occasionally either the stitches will not hold, or there could be a small unrecognized tear and leakage could occur. If that should happen, we would have to take you back to surgery and do another operation to sew up the hole in the dura. Usually this is not a major complication, but you need to be aware of this so that if it does occur it will not be a major shock or surprise to you.
Additional Risks Include:
- Formation of a blood clot in the wound which may require re-operation.
- Infection which may require further surgeries and long term IV antibiotics.
There Are 4 Possible Outcomes From Any Surgery
- Your symptoms or pain may be completely removed.
- Your symptoms or pain maybe partially removed.
- Your symptoms or pain may be the same as before surgery.
- Your symptoms or pain may be worse than before surgery.
Please discuss any concerns with your physician.
Preparation For Surgery
Exam Before Surgery
Before surgery, your doctor may ask you to see your primary care physician for a general exam with blood work. If you have a chronic condition such as heart problems, diabetes, or high blood pressure, be sure to advise your doctor. We may suggest seeing a local specialist here in Tyler while you are in the hospital.
Two Weeks Before Surgery
- You will need to significantly reduce the amount of pain medications, or stop altogether, as your doctor recommends, in order to enhance the effectiveness of pain medications after surgery. If, however, you are taking Oxycontin, continue to take it until the day of surgery. (Do not take it the morning of surgery.)
- There are a number of medications that are important to monitor before surgery. Your doctor will discuss this with you. The major medicine that needs to be discontinued includes blood thinners such as Coumadin, Heparin, and any kind of aspirin containing product or anti-inflammatory medication which is labeled as a non-steroidal anti-inflammatory medication (NSAID). NSAIDs include aspirin, ibuprofen, Advil, Motrin, Daypro, and Naprosyn. These medications have been associated with an increased incidence for bleeding after surgery, and we recommend that the medication be discontinued for a period of 7 to 14 days prior to surgery. There is a new class of NSAIDS– including Vioxx and Celebrex– that may be taken until 2 days before surgery. (Stop taking these two days before your surgery date.) This will be discussed with the doctor who prescribes those medications.
- If you take herbs or alternative prescriptions, please advise your doctor. Some of these can cause odd interactions with common drugs.
- Your doctor will discuss the importance of stopping smoking. It will also be important not to smoke for at least 24 hours before surgery in preparation for anesthesia. This is important.
The Night Before Surgery
Eat or drink nothing after midnight – this includes food, water, coffee, chewing gum, etc. If you take a medication regularly, you may take it with a small sip of water.
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