Posterior Cervical
Laminectomy

An Overview

Posterior cervical laminectomy and fusion may be performed to remove pressure (decompress) the spinal cord, nerve roots and stabilize the neck (fusion).

Disc degeneration, bulging or herniated disc(s), osteoarthritis (spondylosis), and spinal stenosis are disorders that may compress the spinal cord and nerve roots. Compression or pinching of these neurologic

structures may result in neck, shoulder, upper back, and arm pain. Other neurologic symptoms may include numbness, tingling and weakness in the arms or hands.

The goal of posterior cervical laminectomy and fusion is to decompress the spinal cord and nerve root(s), stabilize the neck, relieve symptoms, and enable patients to return to regular activities of daily living.

Posterior = back

The surgical incision is made in the back of the neck.

Cervical = neck

The cervical levels are one region of the spine. There are seven vertebral bodies in the neck; numbered C1 (top) through C7 (bottom). The disc levels are also abbreviated. For example, C3-C4 refers to the intervertebral disc between the third and fourth cervical vertebral bodies (bones).

Laminectomy = to removethe lamina

The lamina is a thin plate of bone at the back of the neck that makes up the roof of the spine and helps to protect the spinal cord. During Dr. Akamnonu's NYC laminectomy, the bony plate is removed to allow him access to the spinal cord and other nerve structures.

Fusion = to join or combine

Bone graft is inserted into the empty space between the upper and lower vertebral bodies. Instrumentation (rods and screws) is implanted to immobilize (stabilize) the neck. The body’s natural healing processes cause new bone to grow into and around the instrumentation resulting in a spinal fusion.

Not every patient with a cervical degenerative disc problem, herniation or spinal stenosis requires spine surgery. Dr. Akamnonu may recommend posterior cervical laminectomy and fusion for the following reasons: if non-operative treatment fails to relieve symptoms, progressive worsening of neurologic symptoms or pain, spinal instability, and/or neurological problems. Numbness, loss of function, and weakness are examples of neurologic dysfunction. Loss of manual dexterity, difficulty with fine motor movements, and disruption of walking balance may be signs of myelopathy and signal dangerous compression of the spinal cord within the spine.

Type of Bone Grafts

One or more post-operative x-rays are taken to ensure that the bone graft, rods, and screws are well-positioned. The wound is closed and bandaged.

Autograft is the patient’s own bone. Autograft may be bone taken from the patient’s neck during a laminectomy or in a separate procedure where bone is taken from the patient’s hip.
Allograft is donor bone from a bone bank.
Bone graft substitute; there are different types, some of which are synthetic (man-made) and available in different shapes.

About Posterior Cervical Laminectomy and Fusion

Posterior cervical laminectomy and fusion is performed under general anesthesia. The neck is shaved, cleaned and prepared for surgery. The patient is positioned face down (prone) on the operating table. The patient’s skull is held securely in position and neck immobilized by means of a device made for this purpose. A special monitoring system checks the spinal cord and nerve function throughout the procedure to prevent injury. Fluoroscopy, a type of real-time x-ray is used throughout the surgery to see the patient’s anatomy and guide instruments.

A skin incision is made in the middle of the back of the neck (a midline incision). Muscles and other soft tissues are moved away from the spine. Special surgical instruments are used to carefully remove the lamina and remove tissue and bone compressing the spinal cord and nerve structures. The lamina and other bone removed may be prepared and used for bone graft. Rods, screws and bone graft are implanted to stabilize the neck and to facilitate fusion and healing.

After Surgery

After surgery, the patient is moved into the recovery area. In recovery, nurses and medical team members closely monitor the patient’s vital signs – pulse, respiration, blood pressure, and pain. Some post-operative pain should be expected and patients receive pain medication either through their IV (intravenous line) or by mouth.

A post-operative cervical brace, collar or halo is prescribed to wear for a time period after surgery to help immobilize and support the neck while healing.
A typical hospital stay is 2 to 3 days. Dr. Akamnonu discusses hospitalization with patients before their surgery date.

Aftercare at Home

Patients are provided with posterior cervical laminectomy and fusion information about what to expect and self-care after hospital discharge. This information includes instructions to control pain, medications, brace/collar/halo care, diet and managing constipation, bathing and incision care, activity restrictions, and the surgical follow-up appointments.