Posterior Cervical Laminectomy and Fusion

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Disc degeneration, bulging or herniated disc(s), spondylosis, and spinal stenosis are disorders that may compress the spinal cord and nerve roots. Neck, shoulder, and arm pain are common. Other symptoms include numbness, tingling, and weakness in the upper extremities. Posterior cervical laminectomy and fusion is a procedure that decompressed the spinal cord and nerve root(s), stabilize the neck and relieve symptoms.

Anatomy

There are seven vertebrae in the neck (cervical region), numbered C1 (top) through C7 (bottom). The discs between the vertebrae are also abbreviated. For example, C3-C4 refers to the disc between the third and fourth cervical vertebrae.

 

  • Posterior – surgical approach from the back
  • Cervical – refers to the neck
  • Laminectomy – removal of a portion of vertebral bone, the lamina
  • Fusion – joining bone to heal together

 

The lamina is a thin plate of bone at the back of each vertebral body. Collectively, the laminae make up the roof of the spine and help to protect the spinal cord.  During laminectomy, this portion of the vertebra is removed to allow the surgeon access to the spinal cord and other nerve structures.

The Procedure

Surgery is performed under general anesthesia. A special monitoring system checks the spinal cord and nerve function throughout the procedure.  Fluoroscopy, a type of real-time X-ray, is used to enhance visualization of the operative site.

 

An incision is made in the middle of the back of the neck. Muscles and other soft tissue are moved away from the spine. The lamina is carefully removed, along with tissue and/or bone compressing the spinal cord and nerve structures. Once the surgeon has performed decompression, bone graft is inserted into the empty space between the affected vertebrae. Instrumentation, such as rods and screws, is implanted to stabilize the neck and facilitate fusion. Over a period of months, new bone grows into and around the instrumentation and fuses the spine.

Types of Bone Graft

Autograft is the patient’s own bone.  Autograft can be taken (harvested) from the patient's neck during laminectomy or from the patient's hip in a separate procedure. Allograft is cadaver bone from a bone bank.

 

In addition, the surgeon may elect to use a bone graft substitute. Synthetic bone graft eliminates the need to harvest bone from the patient and sometimes results in a stronger fusion.

After Surgery

The average hospital stay for patients who undergo posterior cervical laminectomy and fusion is two to three days. Patients are usually required to wear a cervical brace or collar for a period of time following surgery, as it takes several months for the vertebrae to fully “fuse.” Cervical braces are prescribed to help immobilize and support the neck during recovery.

 

Once discharged, patients typically experience a significant reduction in pain. Instructions regarding pain control, diet, wound care, and follow up appointments are provided. Most important, activity restrictions are reviewed prior to discharge. Although activity will be restricted in the early stages of recovery, most patients steadily progress during the weeks and months following surgery.