Overview

Posterior cervical laminectomy

Cervical stenosis can place pressure on the spinal cord. If most of the compression is in the back, this condition can be treated with a posterior cervical laminectomy. The objective of this procedure is to remove the lamina (and spinous process) to give the spinal cord more room.

The general procedure for a cervical laminectomy includes the following:

1. Surgical approach

• The skin incision is in the midline of the back of the neck and is about 3 to 4 inches long.

• The para-spinal muscles are then elevated from multiple levels.

2. Removal of the lamina

• A high speed burr can be used to make a trough in the lamina on both sides right before it joins the facet joint.

• The lamina with the spinous process can then be removed as one piece (like a lobster tail).

• Removal of the lamina and spinous process allows the spinal cord to float backwards and gives it more room.

The results of the laminectomy are variable, since some people have more extensive disease than others. In general, after the laminectomy most patients can expect to regain:

• Some spinal cord function

• Improvement in their hand function and walking capabilities

• Less or no numbness in their hands (if there was a lot of numbness prior to the surgery, it probably won’t go away completely)

If the back surgery simply prevents progression of the spinal cord damage (myelopathy) and there is no loss of function due to the surgery, both the patient and spine surgeon should consider it successful.

Potential risks and complications of laminectomy back surgery
As with cervical corpectomy (also done for cervical stenosis with myelopathy) the principal risk is deterioration in neurological functioning after the back surgery.

To help manage this risk, the spinal cord function is often monitored during surgery by Somatosensory Evoked Potentials (SSEP’s). SSEP’s generate a small electrical impulse in the arms/legs, measure the corresponding response in the brain, and record the length of time it takes the signal to get to the brain. Any marked slowing in the length of time may indicate compromise to the spinal cord.

Other potential risks include:

• Dural tear

• Infection

• Bleeding

• Increased pain

• Instability in the spinal column

Cervical fusion surgery
Cervical laminectomies are sometimes done with a cervical fusion surgery. If a posterior laminectomy is done without a cervical fusion surgery, there is a post-operative risk of developing instability that may lead to pain and deformity. Therefore, there is a risk that a spine fusion will be needed at some point in the future.

Posterior laminoplasty back surgery
In order to reduce the risk of post-operative instability and to avoid a spine fusion, some spine surgeons will recommend lifting the lamina on one side and leaving a hinge on the other side.

• The advantage of this technique is that it increases the size of the canal but leaves the posterior tether that helps keep the spine stable.

• The disadvantage is that the canal is not well visualized and it is difficult to assess whether or not the canal has been well decompressed.

By: Peter F. Ullrich, Jr., MD
October 7, 2005 (article originally published September 8, 1999)