A posterior cervical
laminectomy for avm (arteriovenous malformation) is
generally performed to remove an avm from within or
surrounding the spinal cord. The patient is lying on
their abdomen, with their head in a Mayfield head holder (pins
in a clamp hold the head in place). A linear incision
is made in the back of the neck, in a vertical (up and down)
manner. The surgeon will then dissect down, through
the subcutaneous tissues, to the fascia (firm membrane) overlying
the spinous processes ( bones protruding from the back of
the spine). The surgeon will then pull the muscle away
from the bones, exposing the extent of the roof of the spinal
canal on both sides. Generally, under microscopic vision,
the surgeon will drill or bite away the laminae (the bone
covering the spinal cord). At this point, the dura,
which is a tough membrane covering the cord, is opened.
The avm may be seen involving or surrounding the cord, or
it may be buried within the spinal cord. Following
the removal of as much avm as possible, the surgeon will close
the spine. The dura will be closed with suture.
The surgeon will then close the various muscle and skin layers
with suture, and the skin with suture or staples. The
wound is then dressed in a sterile manner.
cervical laminectomy with avm removal has substantial risks,
depending on the type and location of avm. Since
this procedure is relatively uncommon, your surgeon will describe
the risks specific to the type of avm you have. These
can be broken down into two categories, 1) those related to
the operative site, and 2) those related to the risks of anesthesia.
related to the operative site:
Exposure: The patient is placed in a prone position
(on their abdomen), with the head fixed in Mayfield head
pins. This is a clamp which fixes the head in position.
This is an extremely safe device, but there can be potential
lacerations in the skin, as well as infection.
In this position, there can be pressure sores, pressure
injuries to nerves, and injury to the eyes as a result of
pressure to them.
During surgical dissection, injury to muscle surrounding
the spine can occur.
Root injuries: If there is any injury to the spinal
cord or nerve roots, the consequences may involve loss of
sensation, increased burning sensation, paralysis, weakness,
loss of bowel, bladder, sexual function. There may
be a spinal fluid leak postoperatively, as the covering
of the cord (dura) is widely opened during the procedure
to gain access to the avm. Although the surgeon will
attempt to remove as much of the avm as possible, there
may be a small or large amount of avm left behind.
Control of the diaphragm responsible for breathing,
eminates from the upper cervical spinal cord. If this
area is damaged, the patient may need a permanent tracheostomy
(hole in the windpipe), to provide a diversion of the route
air takes to enter the lungs. A feeding tube may also
be needed, postoperatively.
Risks: These include such general difficulties,
such as bleeding, infection, stroke, paralysis, coma and
death. The scar on the neck may be tender, or may
heal in an unpleasant manner. There is also the possibility
that the surgery may not relieve the symptoms for which
the procedure was performed. The problem for which
the surgery was performed may recur, requiring additional
surgery in the future. In addition, although every
attempt is made to protect all areas of the body from pressure
on nerves, skin and bones, injuries to these areas can occur,
particularly with prolonged cases.
Anesthesia: Blood clots in the legs, heart attacks,
reaction to the anesthetic, reaction to blood transfusion,
if it given.
You may be
required to wear a soft or firm cervical collar postoperatively.
There shall be no bending, twisting, or heavy lifting for
several weeks after surgery. Physical therapy may
or may not be implicated. Your doctor will gradually
ease your work restrictions, depending on your progress.
keep the wound dry and clean. Notify your surgeon
of any drainage or temperatures greater than 101 Fahrenheit.
You may experience
some continuing incisional pain and occasional spasms in
the back of your neck from time to time. There
are several steps you can take which will help speed your
recovery as well as give you the best chance for a successful
upon discharge, contact our office and set up an appointment
for staple removal is one has not already been set up.
- Wear the
collar given to you by your surgeon. It should be
worn continuously except when showering or shaving, unless
instructed otherwise by your surgeon.
- Do no drive
until cleared with your physician.
- Avoid riding
in a car more than 50 miles.
- When shaving,
avoid tilting your neck back. When washing your
hair, do it in the shower and not in the sink.
- Begin an
exercise program of walking to gain strength.
- Lift nothing
heavier than one pound (one quart of milk).
- No jogging,
weight lifting, or other heavy exercise for now.
- Do not raise
your arms above your head.
- You may
shower with the incision covered.
- You may
engage in sexual relations.
- In doing
any activity in which you notice an increased amount of
neck, shoulder or arm pain, STOP. Your body is telling
you that you are doing too much.
- If you notice
any swelling, redness or opening of the incision, notify
your surgeon immediately. If any clear or purulent
fluid drains from your neck, notify your surgeon immediately.
- If you develop
fever or a stiff neck, notify your surgeon immediately.
- If you have
any questions, please do not hesitate to call your surgeon.
- Take your
temperature at 4:00 PM daily until clips/sutures are removed.
- Take your
medications as prescribed by your physician.
- It takes
6-18 months for a nerve to heal. You may have numbness,
tingling, creepy crawly sensations or fleeting pain during