A posterior cervical
laminectomy with fusion is generally performed to decompress
the spinal cord within the cervical spine. The
surgeon may elect to fuse because of instability.
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 cpinal cord). At this
point, the spinal cord which has been pinched by disk or bone,
can be decompressed. Sometimes the veins around the
spinal cord can bleed, and this is often controlled with local
temporary pressure. The surgeon may then place hardware
with the spine to support it and aid in fusion. These
may be loops, rods, or plates help in place by screws.
Bone might be taken from the hip. The surgeon will then
close the various muscle and skin layers with suture, and
the skin with suture or staples. The would is then dressed
in a sterile manner.
cervical laminectomy with fusion, even though a common procedure,
does have certain risks. 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, which could occur after a tear of
the covering of the spinal cord or nerve root.
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.
When the hardware (instruments placed to hold the spine
together) is placed, nerve roots or the spinal cord can
be injured. In addition, the bone may not properly
fuse. The propensity for non-fusion and continued
pain is higher in smokers. Cessation of smoking improves
the chances of a successful fusion. There can be pain
and the standard risks of bleed and infection associated
with the site on the body from which the bone for grafting
is taken (often the hip). In addition, hardware can
break and pull out from the spine.
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 firm cervical collar, brace or halo 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. Any numbness
which you had in your hands prior to surgery may continue
as well. There are several steps you can take which
will help speed your recovery as well as give you the best
chance for a successful outcome.
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 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