Cervical Laminoplasty & Laminectomy
Cervical laminectomy and laminoplasty are procedures that are performed from the posterior or back of the neck to remove pressure on either the nerve roots or the spinal cord. A laminectomy removes the lamina, or bony roof, over the spinal cord while a laminoplasty hinges the roof open to provide more space for the spinal cord without loss of bone. A laminectomy can be combined with a posterior cervical fusion.
Cervical laminectomies and laminoplasties are designed to relieve pressure upon the spinal cord or nerve roots. In most cases, patients have severe neck or arm pain from pinching of the spinal cord or nerves. Sometimes patients experience myelopathy or weakness in the legs. Other indications include instability due to disc degeneration, fracture, tumor, or scoliosis.
In order to perform a cervical laminectomy or laminoplasty, an incision is made over the back of the neck, centered over the segments of the cervical spine that need to be decompressed. The incision is carried through the skin, fascia, and muscles until the spine is exposed. The laminectomy involves removing the lamina, which is the bony covering of the spinal canal, where the nerve roots and spinal cord are situated. In a situation in which there is only a small area of pressure on the nerves, a limited laminectomy, called a laminotomy, is carried out. Laminoplasty is when the lamina is broken and then hinged open to provide more space for the nerves.
During the surgery, the patient is in a prone position, lying face down. The surgery is done under a general anesthetic, with the patient completely asleep.
Most patients spend 2 days in the hospital after the surgery and are not allowed to lift more than 10 pounds for one month afterward. A soft collar is frequently used for comfort. Patients should not expect to drive for at least 2 weeks.
There are several risks to cervical laminectomy and laminoplasty that include nerve damage to the spinal cord or nerve roots. Nerve root damage may lead to weakness in an arm and is uncommon but can be permanent. Spinal cord injury resulting in paralysis is quite rare.
Infection is a complication that can occur 1% to 3% of the time. This may require further surgery, and/or antibiotics.
The risk of a spinal fluid leak is about 1% but can lead to prolonged hospitalization while patients recover and at times require another surgery to repair the leak.
At times a laminectomy or laminoplasty is unable to completely relieve the pressure upon nerves or the spinal cord and a cervical fusion is needed at a later date.
The success rate is dependent upon the underlying condition requiring surgery. A large majority of patients see significant pain relief with the surgery. 75% of patients with spinal cord compression and myelopathy see improvement in those symptoms.
Our overall advice for this type of surgery is the same for any other spine surgery, which is to live with the pain you are experiencing if you can. The reason for undergoing the operation is that the pain or weakness is making life so uncomfortable or difficult that you are willing to accept the chance of a result that is less that 100% successful.