A cervical laminectomy is generally conducted to aid spinal stenosis by decompressing the cervical spine. It is not a procedure which is conducted to remove a diseased lamina, rather to free up space in the spine for compressed nerves and blood vessels. The lamina consists of the two laminae, or two sides, of the bone that covers the spinal cord, and by removing this, and any bone spurs around the nerves, it is possible to create space for the spinal cord, nerves, and blood vessels of the cervical spine. It is usual to have this procedure when the pressure on the spinal cord is not manageable by conservative treatment. If the symptoms are a result of a herniated disc, or curvature of the spine (such as in ankylosing spondylitis), alternative procedures such as an anterior cervical discectomy or foraminotomy may be performed instead (Houten, 2003).
What is a Laminectomy?
The term laminectomy covers a multitude of surgeries, the basic one being the removal of a portion of the lamina (back bone). Laminectomy may also be performed in order to create access for a posterior cervical discectomy, where a herniated disc is removed by approaching from the back of the spine. Usually more than just the lamina is removed during this type of neck surgery, with osteophytes, calcified cartilage, and other troublesome materials removed to make space for the compressed spinal cord and nerves. Traditionally, laminectomy involves the removal of ligaments and muscles in the spine as well as a large portion of the back bone. More minimal surgeries may simply excise the lamina whilst the muscles are pushed aside, rather than cutting them. A laminotomy is a similar procedure, but not as extensive, and both differ from a laminoplasty.
Laminectomy with our without a fusion
The procedure may be performed with or without fusion depending on the surgeon’s assessment of the stability of the spine. The patient will be face down on the operating table under general anaesthetic during the procedure and a small incision will be made in the back of the neck in order to gain access to the laminae. In order to monitor the status of the spinal cord during the procedure, the surgeon may use somatosensory evoked potentials (SSEPs). Any reduction in nerve impulse transmission may mean that the spinal cord is being impacted negatively by the surgery, and measures will be taken to correct this. Surgeons may use a bone graft, metal plates and screws, loops and rods, or a combination to support the spine and promote fusion after surgery. If a laminectomy is performed without fusion it may lead to instability, pain, and spinal deformity at a later date, necessitating fusion at that time.
Surgery is quite invasive and often takes substantially longer to recover from than some of the other, relatively simpler, spinal surgeries available. Some patients take just a few weeks to get back to good health, others can take a year or more. Laminectomy does not halt the degeneration of the spine and, as such, some patients may have a recurrence of symptoms due to new damage within a few years of the surgery. This varies between individuals. Laminectomy without fusion is particularly beneficial if a patient has severe neurogenic claudication from spinal stenosis; patients usually experience a rapid recovery and have good long term prospects. Fusion after laminectomy, in cases where the spine is unstable, tends to result in a longer recovery time, with less overt symptom relief.
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