Cervical Laminectomy
The spinal cord needs adequate space inside the spinal canal. The spinal canal is a protective ring of bone that surrounds the spinal cord. Conditions such as fractures, dislocations, tumors, or degenerative changes in the discs and joints of the neck can put pressure on the spinal cord. This is due to the protective ring of bone around the spinal cord, which does not expand to accommodate more space. Extra pressure within the confined space of the spinal canal can place the entire spinal cord in danger. Surgery to open the back of the spinal cord is one way to relieve pressure. This procedure is called laminectomy.
Neck Anatomy
In order to understand your symptoms and treatment choices, it is helpful to start with a basic understanding of the anatomy of the neck. This includes becoming familiar with the various parts that make up the cervical spine and how they work together.
The vertebral body is a column of individual bones that make up the spine (spinal column). Each level of the spine protects the front of the spinal cord. The pedicle and lamina bones form a protective barrier that surrounds the sides and back of the spinal cord. The pedicles connect to the vertebral body, while the lamina bones attach to the pedicles. The lamina bones cover the back surface of the spinal canal, forming a protective roof over the spinal cord.
Rationale For A Cervical Laminectomy
Bone spurs or a herniated disc can take up space inside the spinal canal and put pressure on the spinal cord. This condition is called spinal stenosis. If spinal stenosis is the main cause of your symptoms, the spinal canal may need to be enlarged. Bone spurs that are pressing on the nerves may need to be removed. This can be achieved with a complete laminectomy. Laminectomy means “remove the lamina”.
Removing the lamina gives more room for the spinal cord and spinal nerves, while also relieving pressure. A spine surgeon may remove bone spurs which are causing irritation and inflammation around the spinal nerves.
Surgical Procedure
The surgeon begins by making an incision down the center of the back of the neck. The neck muscles are then moved to the side.
Upon reaching the back surface of the spine, the surgeon uses an X-ray to identify the problem vertebra. The lamina is removed, taking the pressure off the back part of the spinal cord and nerves.
Removing the entire lamina in the cervical spine may cause problems with stability. If the facet joints are damaged during the laminectomy, the spine may become unstable and cause problems later. One way that spine surgeons try to prevent this problem is by cutting one side of the lamina and folding it back slightly, instead of removing the lamina completely. The other side of the lamina opens like a hinge. This makes the spinal canal larger, giving the spinal cord more room. The cut area of the lamina eventually heals to keep the spine from tilting forward.
Complications
Like all surgical procedures, operations on the neck may have complications. Because the surgeon is operating around the spinal cord, neck operations are always considered extremely delicate and potentially dangerous. Take time to review the risks associated with cervical spine surgery with your doctor. Make sure you are comfortable with both the risks and the benefits of the procedure planned for your treatment.
Rehabilitation
You’ll be able to get up and begin moving within a few hours after surgery. Your doctor may have placed you in a neck collar. Limit your activities to avoid doing too much too soon. Most patients are able to return home when their medical condition is stabilized, usually within a few days after surgery.
Physical Therapy
Your doctor may have you attend physical therapy beginning four to six weeks after surgery. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength and helping you do your daily activities with greater ease and ability. Therapy sessions may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you
- Learn how to manage your condition and control symptoms
- Improve flexibility and strength
- Learn correct posture and body movements to reduce neck strain
- Return to work safely