Cervical Laminectomy +/- Lateral Mass Fusion
A cervical laminectomy and lateral mass fusion is typically performed to treat myelopathy (spinal cord dysfunction) due to compressive pathology (typically multilevel degenerative arthritis. The objective of this procedure is to remove the lamina (and spinous process) to give the spinal cord more room. The fusion is performed to prevent the development of flexion (kyphotic) deformity, to slow the degenerative process and potentially to temper neck pain.
- This procedure starts with an incision in the back the neck. [The patient is placed in the prone (facedown) position with the head fixated].
- The paraspinal muscles are then elevated from multiple levels exposing the lamina (the bones that form the back of the spinal canal serving both protective and structural roles).
- The lamina and spinous processes are removed utilizing a variety of techniques. This allows the spinal cord to float backwards and gives it more room within the spinal canal.
- Supplemental fusion: Small screws (typically 12 mm in length) are then inserted into the lateral masses of the vertebrae. These are coupled together utilizing small titanium rods. Cadaveric bone (allograft) is then placed on the bony lateral masses and ultimately solidifies, locking the vertebrae together.
- The patient is placed in a rigid cervical collar and mobilized on the night of surgery or the following morning.
- Physical therapy is typically instituted immediately postop, as many patients undergoing the procedure have significant neurologic problems preoperatively.
- Patients typically are discharged home (or to inpatient rehabilitation if deemed necessary) within 72 hours.
WHAT YOU WANT TO KNOW
“Neck surgery? That seems dangerous. Is it?”
The thought of an incision being made in your neck can be daunting. That said, major complications are infrequent. Postop paralysis for example is extremely rare. The most common complaint offered postoperatively is that of neck pain (due to the muscle dissection necessary to access the spine). Other procedure risks include but are not limited to the following:
- C5 palsy (limited shoulder abduction/arm elevation). The majority of these cases resolve within 3 months. Occupational therapy is indicated to accelerate neurologic recovery.
- Wound infection.
- Mechanical complications of the instrumentation (including rod, screw pullout, etc.).
- Development of painful pseudoarthrosis (failure of adequate fusion to occur).
- Damage to the dura, resulting in a cerebrospinal fluid leak or pocket of cerebral spinal fluid beneath the incision (pseudomeningocele).
- Damage to the spinal cord or nerve root(s) resulting in pain, weakness, paralysis, loss of sensation and loss of bowel, bladder and sexual function.
- Arterial injury and resultant stroke.
"Will I have to wear a collar after surgery? If so, for how long?"
Dr. Osborn places his patients in a rigid collar postoperatively. This is to optimize one’s chances for bony fusion. Patients are typically maintained in the collar for 6-12 weeks. A bone stimulator may be prescribed as well.
“Will I have neck pain after surgery?”
Neck pain (if present) is the primary complaint after a cervical laminectomy. This gradually improves as the neck musculature heals. A small percentage of patients however develop chronic neck pain. This is not necessarily an indication of a pseudoarthrosis (failed fusion), although will prompt additional x-rays.
“Is there downtime after surgery?”
Patients are typically mobilized the morning after surgery. Lifting is restricted to 5 pounds for the first six weeks and thereafter liberalized. Normal activities (including driving) are typically resumed after 6 weeks. Physical therapy (inclusive of strength training) may be prescribed to accelerate recovery.
“Does Dr. Osborn perform the entire procedure? Does he utilize any special techniques to ensure my safety?"
Dr. Osborn performs the entire procedure although is assisted by a skilled nurse and/or a scrub tech. He utilizes evoked potentials (SSEP/MEP’s) intraoperatively to assess the integrity of the spinal cord. This serves as an early warning system and is particularly important in the cases of severe spinal cord compression.