What is Posterior Cervical Laminectomy & Fusion?
Posterior=a medical word for “the back”
Cervical=the region of bones that goes from the skull to the bottom of the neck
Lamina=refers to the region of the bone in the back of the neck
“ectomy”=a suffix meaning to remove
Fusion= a surgical technique that joins two or more bones in your spine together to eliminate motion.
So a posterior cervical laminectomy & fusion is a procedure that involves removing the lamina that is pressing on your cervical spinal cord/nerves by going through the posterior part of your neck and fusing these segments of the spine. A fusion usually involves placing a bone graft in order to provide stability and eliminate motion.
Approach
The surgery is done by making a small incision on the posterior (back) aspect of your neck.
The Procedure
Anesthesia & Induction
- Your anesthesiologist will talk to you about the specifics of his/her plan for the procedure. You will find out what medications and what type of anesthesia will be used to keep you pain free and comfortable throughout the operation.
- In general, most patients will undergo general anesthesia during spine procedures meaning you will be asleep and wont remember or feel any pain during the procedure itself. Patients may have pain upon waking up from anesthesia, but this will be managed with intravenous and oral pain medications.
- After a breathing tube is placed and you are fully asleep, you will be positioned on the operating room table.
- Surgery will not begin until you are asleep and given pain medications so that you don’t feel any pain during the procedure.
Incision
- After localizing the correct level with x-ray, a skin incision is made on the posterior aspect of your neck.
- The posterior muscles in your neck are carefully moved off of the bone and held apart with the use of special tools, called retractors.
Performing the Decompression
- Before removing the lamni and degenerative bone that is pressing on your spinal cord and nerves, Dr. Webb will confirm that he is operating at the correct level by taking an x-ray while you are asleep.
- When the level is confirmed, Dr. Webb will then begin the decompression (removing the areas of compression from your spinal cord) portion of the procedure by carefully remove the bone that is pressing on your spinal cord/nerves with the use of special instruments and tools.
- At times, Dr. Webb will use a microscope during surgery to complete the operation. This allows him to see small structures, such as your nerves, with finer detail.
- With the diseased disc removed, any additional surrounding structures which may be pressing on your spinal cord, such as bone spurs and/or excess ligaments, will be removed.
- Dr. Webb will then ensure that your spinal cord and nerves are free from compression.
Performing the Fusion
- After the spinal cord has been decompressed and all compressive structures are removed, Dr. Webb will then perform the fusion and instrumentation aspect of the procedure.
- Screws and rods will be carefully placed into the bones of your neck to stabilize the degenerated areas of your spine.
- Bone graft material will then be used to fuse this area as well.
Closure
- The retractors that held the muscles apart, so Dr. Webb can complete the decompression, will now be removed. The muscles that were moved will then fall back into their original place.
- Dr. Webb uses sutures to close your wound and sometimes staples. These sutures or staples will need to be removed, usually 2-4 weeks after surgery.
- Sometimes, a special tube called a drain will be placed during surgery. This tube is to collect any blood or fluids that can collect after surgery. This drain will be removed before you leave the hospital, usually the next day after surgery.
What to expect after Surgery?
After surgery you will be transferred to the recovery room, also called the PACU (post anesthesia care unit). After you have awaken from the anesthesia, you will then be transferred to your hospital room. This is typically when your family members can visit you.
Either the same day or the following morning after surgery, a physical and/or occupational therapist will begin your therapy. During your hospital stay, you will be given medications to help with pain and IV antibiotics to minimize the risk of infection. Most patients spend 2-3 nights in the hospital and are discharged home after:
- You are tolerating a diet
- Your pain is controlled
- After you have worked with and passed physical therapy.
Walking after surgery is highly encouraged, even the same day of surgery!
Frequently Asked Questions
What kind of recovery can I expect after Surgery?
Recovery from a posterior cervical laminectomy and fusion surgery takes 8-12 weeks for the bones to heal, but patients continue to heal for up to a year after surgery.
When can I return to work and/or my activities?
Walking is highly encouraged, immediately after surgery and throughout your post operative period. Most patients can return to a light desk job or household activities by 2-3 weeks after surgery. Patients with jobs that require heavy lifting, strenuous labor, or activities such as biking, skiing, or running will not be allowed to return until Dr. Webb ensures your bones have fused. This is usually around 12 weeks.
When will my neck or arm pain go away?
If you can imagine putting your elbow on a hard surface for a long time, what happens? Your fingers start to go to sleep. Why? Because the nerves to these fingers is compressed, is asleep, and is irritable. Once you realize this, you pick up your elbow (to remove the pressure off of the nerve) and shake your fingers until they wake up.This is a similar concept in spine surgery where depending on how long your nerves and spinal cord have been compressed, will determine how long it takes for the nerve to wake up after the surgery. If you have had compression of your nerves and spinal cord for months to years, then it may take some time before the nerve recovers and wakes up (if it recovers at all). Most patients, however wake up from surgery with arm pain relief meaning that the debilitating arm pain they had before surgery has went away, but may have some neck pain and spasms from the surgical incision itself. This pain will be controlled with oral/IV pain medications and antispasm medications throughout your hospital stay.
When can I expect my bones to fuse together after surgery?
Once Dr. Webb removes the structures (bone spurs, excess ligament, etc) that are compressing your spinal cord and nerves, bone graft, screws and rods will be then placed. This starts the process of spinal fusion. How quickly your bone fuses depends on many factors such as your bone quality, your general overall health, if you are a smoker or not, etc but most patients can expect a solid fusion by 12 weeks post op.
Once Dr. Webb confirms adequate fusion (usually around 3-4 months after surgery), he may then allow you to return to more strenuous activities such as running, biking, etc.
What complications should I be aware of?
Inadequate relief of symptoms
- Dr. Webb is very particular about making sure we target the right level of your spine that may be causing your symptoms.
- Inadequate relief of symptoms after surgery could be due to a number of things including: multiple levels that are degenerated or worn out that will not be addressed in surgery, surgery done on the wrong level, or advanced and severe spinal cord compression that may be irreversible.
- Injections are confirmatory and are very predictive of how well you will do with surgery. These spinal injections, usually done before surgery in the conservative treatment period, are essential in determining which level of your spine is the cause of your symptoms.
- Just because you have multiple degenerated areas of your spine according to your imaging studies (MRI, X-ray, etc.), does not mean every level needs an operation.
Failure of bone graft to heal adequately (called a non-union or pseudarthrosis)
- This risk is elevated if you are a smoker, are older than 60 years old, on chronic steroids, have osteoporosis, or if you are diabetic.
- Smoking cessation, optimizing your bone and general health, and maintaining normal glucose levels are recommended before any spine procedure to give you the best outcome.
- Some patients whose bones do not fuse after this procedure may require additional surgery to reattempt a spinal fusion if their symptoms are bad enough to warrant it.
Nerve damage, causing arm and/or leg weakness and pain
- A neuromonitoring technician is a professional trained in the monitoring of your nerves and spinal cord. This person (along with a Neurologist) is part of the team that will be taking care of you during surgery and will help Dr. Webb monitor your nerves and spinal cord throughout the procedure.
- You will be able to meet this person the morning of surgery and ask any questions about their role in your care.
- Generally, after you are asleep from anesthesia, this technician will place small wires on your legs and arms so that the nerves and spinal cord and be monitored during surgery.
- There are small nerves that control the muscles in your arms and legs that are close to where Dr. Webb will be working. Dr. Webb carefully works around these nerves and ensures they are not damaged during surgery.
- If these nerves become irritated during surgery (sometimes just by touching or moving them), these nerves may cause pain for weeks to months after surgery until the nerve recovers.
- During this time, Dr. Webb may prescribe you nerve medication or steroids to help calm the inflammation down.
- Although a low risk, some patients may wake up with weakness in their shoulders and/or biceps. This is called, C5 nerve palsy and is a condition that is caused by irritation to the nerve responsible for your shoulder and bicep function. You may wake up from surgery with weakness in either one or both of these muscles. This may take several months to recover (if at all) and there are unfortunately not a lot of great options to treat this.
Dural tear
- The dura is the outer layer of the spinal cord. Sometimes, this layer can be especially thin in certain patients and very friable. During surgery, if there is a small tear in this layer, Dr. Webb will attempt to repair it. This is a not a very common complication, but definitely one that needs to be known.
- Sometimes after a dural tear is repaired, Dr. Webb may ask that you sit upright for 24 hours after surgery. This is done to give the repair time to heal and to ensure his repair does not come apart.
- Fortunately, multiple studies have shown that having a dural tear repair does not affect your outcome from surgery.
Infection
- Very low risk (<1%) but this risk is increased if you are overweight, immunosuppressed, on chronic steroids, or diabetic.
- Antibiotics will be given before surgery starts and also given for 24 hours after surgery while you are in the hospital to decrease the risk of infection.
Bleeding
- Very low risk, but increased if you are taking blood thinners, fish oil, herbal medications or have a clotting disorder.
- These medications will need to be stopped before surgery.
- Sometimes, a special tube called a drain will be placed during surgery. This tube is to collect any blood or fluids that can collect after surgery. This drain will be removed before you leave the hospital, usually the next day after surgery.
Adjacent segment disease:
- Fancy word that means the levels above or below your fusion have degenerated faster, because the fused area of the spine places more stress on these levels.
- If this occurs and causes symptoms, Dr. Webb will discuss the next steps to manage this starting with conservative treatment options like physical therapy and/or injections.
- A handful of these patients will require additional surgery to address those degenerated levels.