Posterior Cervical Spine Laminectomy with Fusion

For a posterior cervical spine laminectomy, an incision is made on the back of the neck and the muscles over the lamina (posterior spine) are spread apart. The bony elements of the spine are fully exposed and then, typically, instruments such as screws and rods are placed into the spine. The bones of the spine are then roughened up and bone is placed to obtain a fusion. A fusion occurs when two or more vertebrae in the spine are fused together to create a solid bridge of bone between the vertebrae. Frequently a cervical laminectomy, or removal of the lamina, is also performed to make space for the spinal cord.

Typically, a posterior cervical fusion is done in conjunction with a laminectomy to stabilize the spine in situations where there is spinal cord compression.

One of the most common complications of posterior cervical laminectomy and fusion is a spinal fluid leak. This occurs in about 2% of patients who have never had prior surgery and in up to 10% of patients who have had prior surgery. Spinal fluid leaks are repaired at the time of surgery but usually add 1–2 days to the hospital stay.

Another common complication is nonunion, or failure of the vertebrae to fuse. This occurs in up to 5% of nonsmokers for a one-level fusion and in up to 20% of smokers. Nonunion rates rise with the number of levels of the spine to be fused. Nonunions may necessitate more surgery.

Infection rates average 2-3% and may require further surgery and antibiotics.

Permanent nerve damage is possible but rare, averaging 1-2%. Paralysis is possible but extremely unlikely. Neurologic monitoring of the spinal cord is frequently performed to minimize any chance of nerve or spinal cord damage.

Complications associated with the placement of the screws include bone breakage and nerve damage. The surgeon uses live x-ray imaging to help minimize risks associated with hardware placement.

An epidural hematoma is a collection of blood that can put pressure on the nerves and cause severe pain. They occur in about 1% of cases, are usually recognized in the hospital, and resolve with another surgery to evacuate the blood collection. The surgeon usually places drains during surgery to minimize the chance of an epidural hematoma.

The chances of success largely depend on the reason for surgery. Typically posterior cervical fusion and laminectomy are performed for myelopathy. Myelopathy invariably worsens without surgery, and surgery leads to improvement in about 70% of patients.

If you have myelopathy surgery is indicated to prevent further neurologic worsening, weakness, and inability to walk. If myelopathy is not present then fusion is generally an elective surgery. We recommend that you do not have surgery if you can live with your current level of pain or can make changes in your lifestyle to decrease the pain. If you have made a valiant effort and the pain still persists, surgery may be your next step.

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