What is a cervical laminectomy?Inamdar Hospital
What is a cervical laminectomy?
A cervical laminectomy is performed to relieve the pressure on the spinal cord in your neck.
A cut will be made in the skin at the back of your neck. X-rays will be taken during surgery and used to confirm the correct levels of the spine. Small portions of bone and ligaments will be removed from the affected cervical spine to relieve the pressure on the spinal cord.
The cut will be closed with stitches or staples.
What exactly is wrong with my neck?
The spinal canal and intervertebral for aminae are bony tunnels in the spine through which run the spinal cord and spinal nerves (nerve roots) respectively. When the size of these tunnels is reduced, there is less room for the spinal nerves and/or spinal cord, the consequence of which may be pressure on these structures.
Symptoms of neural (nerve or spinal cord) compression include pain, aching, stiffness, numbness, tingling sensations, and weakness. As spinal nerves branch out to form the peripheral nerves, these symptoms may radiate into other parts of the body. For example, cervical nerve root compression (pinched nerves in the neck) can cause symptoms in the shoulders, arms, and hands.
Disorders that can cause nerve root compression include spinal stenosis, degenerative disc disease, a bulging or prolapsed intervertebral disc, bony spurs (osteophytes), or spondylosis (osteoarthritis of the spine). Commonly, two or more of these conditions are seen together.
Intervertebral discs sit between each bone (vertebrae) in the spine. They act as shock absorbers as well as allowing normal movement between the bones in your neck. Each disc has a strong outer ring of fibres (annulus fibrosis), and a soft jelly-like central portion (nucleus pulposis). The annulus is the toughest part of the disc, and connects each vertebral bone. The soft and juicy nucleus of the disc serves as the main shock absorber. An annular tear is where the annulus fibrosis is torn, often the first event in the process of disc prolapse. An annular tear can cause neck pain with or without arm pain. A cervical disc prolapse (or herniation) occurs when the nucleus pulposis escapes from its usual position and bulges into the spinal canal, sometimes placing pressure on the nerves or spinal cord.
In degenerative disc disease the discs or cushion pads between your vertebrae shrink, causing wearing of the disc, which may lead to herniation. You may also have osteoarthritic areas in your spine. This degeneration and osteoarthritis can cause pain, numbness, tingling and weakness from pressure on the spinal nerves and/or spinal cord.
Osteophytes are abnormal bony spurs which form as part of the degenerative process or following a longstanding disc prolapse. This extra bone formation can cause spinal stenosis as well as intervertebral foraminal stenosis, resulting in compression of the spinal cord and/or spinal nerves.
Patients with a painful deformity in their cervical spine may benefit from surgery to straighten and stabilize the spine. Deformity correction is often undertaken at the same time as a decompressive surgical procedure.
As the neck is so flexible (it has to be to perform its usual functions), it is vulnerable to serious injury. Significant trauma can cause a fracture and or dislocation of the cervical spine. In a severe injury the spinal cord may also be damaged. Patients with a fractures and/or dislocations, especially with spinal cord damage, frequently require surgery to relieve pressure on the spinal cord and stabilize the spine.
Instability of the neck may cause neck pain as well as neural compression. This may be the result of trauma, rheumatoid or osteoarthritis, tumour or infection. Instability frequently mandates surgical stabilisation.
What are the risks of this specific procedure?
There are risks and complications with this procedure. They include but are not limited to the following.
Common risks and complications (more than 5%) include:
- Infection, requiring antibiotics and further treatment.
- Minor pain, bruising and/or infection from IV cannula site. This may require treatment with antibiotics.
Uncommon risks and complications (1-5%) include:
- Bleeding is more common if you have been taking blood thinning drugs such as anticoagulants (eg warfarin, dabigatran, rivaroxaban), antiplatelets (eg aspirin, clopidogrel, dipyridamole) or supplements like fish oil. Check with the treating doctor or relevant clinical staff if any medication you are taking, that is not list here, acts like a blood thinner.
- Heart attack due to the strain on the heart.
- Stroke or stroke like complications may occur causing neurological deficits such as weakness in the face, arms and legs. This could be temporary or permanent.
- Nerve root injury causing a weak arm/s, or sensory loss. This may be temporary or permanent.
- On-going persistent neck and arm pain. This may not improve after surgery and may continue to deteriorate despite surgery.
- On-going deterioration in symptoms despite adequate decompression.
- Visual disturbance. This may be temporary or permanent.
- Small areas of the lung may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
- Increase risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.
- Blood clot in the leg (DVT) causing pain and swelling. In rare cases part of the clot may break off and go to the lungs.
- Instability or abnormal alignment of the cervical spine may occur that might require further surgery.
Rare risks and complications (less than 1%) include:
- Leakage of cerebrospinal fluid. This may require further surgery.
- Instability of the cervical spine which may require further surgery and fusion.
- Quadriplegia, which may be temporary or permanent.
- Injury to the vertebral artery, which may result in stroke.
- Meningitis may occur requiring further treatment and antibiotics.
- Due to limitations of imaging and body habitus occasionally a wrong level will be operated on necessitating further treatment.
- Death as a result of this procedure is very rare.