Cervical Laminectomy & Laminoplasty

Cervical Laminectomy

A cervical laminectomy is a surgical procedure that can effectively relieve compression of the spinal nerves and so reduce the pain of spinal stenosis. Cervical spinal stenosis is a condition that involves a narrowing of the spinal column in the neck area. It often produces pain, cramping, weakness or numbness in the neck, shoulders or arms. This condition can develop as a result of injury to, or deterioration of, the discs, joints or bones within the spinal canal. Because the vertebrae of the neck are more capable of movement than any other area of the spine and because they are not only responsible for protecting the spinal cord, but for supporting the skull, surgical repairs in this area are a delicate matter.

While many cases of spinal stenosis can be successfully treated through conservative methods such as rest, wearing a back brace, engaging in physical therapy, or taking nonsteroidal anti-inflammatory drugs, some patients do not respond to these measures. If the symptoms of spinal stenosis become progressively worse, a cervical laminectomy may become necessary.

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The Cervical Laminectomy Procedure

In a cervical laminectomy procedure, a small section of bone that covers the back of the spinal cord, called the lamina, is removed. The removal of this portion of the bone and any nearby bone spurs relieves the pressure on the spinal cord.

A laminectomy of the cervical spine is performed through the upper back and neck while the patient is under general anesthesia. The surgeon makes an incision and carefully retracts the muscles and ligaments to obtain access to the spine. An imaging device such as an X-ray is typically used during the surgery to view the vertebral structures more precisely and pinpoint the problem area.

Depending on the extent of the damage, the lamina may be removed in portions or in its entirety on both sides of the spine. The surgeon will then assess the region, removing any calcified cartilage as well as the spinous processes, the sharp protrusions at the back of each vertebrae, if necessary. By removing the lamina, bone spurs and other debris, the compression of the spinal cord and spinal nerves is alleviated and symptoms improve.

If the bones within the cervical spine have been moving against each other, a spinal fusion procedure may be necessary to promote stability. This procedure can be performed at the same time the patient is undergoing the cervical laminectomy. The fusion involves inserting a bone graft into the space between the affected vertebrae in order to join them. The bone graft is harvested from another part of the patient’s body or is received from a donor bank The surgeon will also attach titanium metal rods, plates and screws to the vertebrae to prevent movement of the bones during the fusion process.


Recovery From Cervical Laminectomy

A cervical laminectomy should relieve much or all of the pain and numbness in the arms and neck that stenosis sufferers experience. After the procedure, the patient typically remains in the hospital for a short stay and may be fitted with a neck brace for temporary support.

Soon afterward, most patients begin a physical therapy regimen to build up muscle strength and increase flexibility. Patients are advised to refrain from reaching, lifting, pushing or pulling for several weeks after the procedure. Usually, they can return to work in approximately 3 months. When a cervical laminectomy is accompanied by spinal fusion, recovery time may be somewhat longer.

Risks Of Cervical Laminectomy

Cervical laminectomy is a spinal surgery procedure and as such, carries some risk. These risks include postsurgical infection, excessive bleeding, blood clot formation, nerve damage and adverse reaction to anesthesia.


Laminoplasty

A laminoplasty is a surgical procedure designed to relieve the nerve pressure and pain caused by spinal stenosis. Spinal stenosis is a narrowing of the spinal canal that puts pressure on the spinal nerves and causes pain throughout the spine and extremities. It can develop as a result of certain genetic abnormalities, disease processes or simply due to natural aging. During a laminoplasty, the lamina, a small section of bone that covers the back of the spinal cord, is cut through completely on one side and partially on the other, enabling it to swing open like a door. It is then held open with titanium spacers and plates, increasing the amount of room around the spinal cord and decreasing compression on the nerves.

Spinal stenosis can occur anywhere in the spinal column, in the cervical (neck), thoracic (chest), or lumbar (low back) regions. Generally, the symptoms of spinal stenosis worsen over time, and conservative treatments. such as medication and physical therapy become less effective in treating the condition. When this occurs, a laminoplasty may become necessary. The procedure can provide relief from the typical symptoms of spinal stenosis, such as back pain and numbness or weakness in one or both arms or legs.

A laminoplasty can be performed on the any of the three regions of the spine, depending on where the patient is experiencing the most intense symptoms. The operation may be performed from the back or the front of the body, depending on the particulars of the patient’s condition. If a bone spur is present nearer to the anterior of the body, for example, the surgeon may enter the body from the front.

A laminoplasty is sometimes performed using microsurgery which is less invasive than traditional methods, but which requires both specialized training and specialized operating equipment. A laminoplasty is a less intrusive alternative to another operation for stenosis called a laminectomy. Unlike a laminectomy, a laminoplasty does not remove the lamina and so manages to preserve spinal stability. This is an advantage because it helps the patient to maintain mobility and diminishes the need for future procedures to restabilize the spine.

After any type of laminoplasty, patients need to undergo rehabilitative therapy to build up strength and flexibility in the area operated upon. Recovery times vary depending on the age and medical condition of the patient. Patients are restricted from activities that require bending or lifting for several weeks after surgery. Most can resume normal activities within 2 to 6 weeks.

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