Posterior Cervical Decompression (Laminectomy) and sos Stabilization
Overview: Posterior Cervical Decompression surgery (laminectomy) is a surgery done through an incision through back of neck. This procedure opens the bony canals through which the spinal cord and nerves pass, creating more space for them to move freely, thus relieving the compression.
Posterior Cervical Decompression or Laminectomy is a commonly performed procedure, whose goal is the relief of spinal cord compression. It is advised for treatment of cervical spinal stenosis and myelopathy. In myelopathy, the aim of surgery is to halt the progression of spinal injury and hence the symptoms due to compression.
Surgery is usually suggested as the last resort. Failure of medical management, biomechanical instability, deformity and severe neurological compression causing weakness are usual circumstances when surgery is advised. In very few cases causing weakness of arms/legs is an emergency procedure recommended. After a thorough discussion (understanding risks and benefits) with the surgeon, the decision for surgery is taken.
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The procedure is done under general anaesthesia. A tube is inserted in the throat to help breathing during anaesthesia. Patient is placed prone (face down) on the operating table. Shaving of posterior hairline may be done pre operatively. Sometimes neuromonitoring (monitoring of nerves and spinal cord) may be done to forsee and prevent neurological damage that can happen during surgery. A posterior (back of neck) 10-15 cms incision is taken. The spinal canal is exposed after dissecting the muscles of the neck. The surgical level is confirmed under C-arm (intra operative X-ray). The bones (laminae) and soft tissues compressing the spinal cord are removed. Magnification with microscope/ loupes is recommended. A high speed burr can be used to make a trough in the lamina on both sides right before it joins the facet joint. The lamina with the spinous process can then be removed as one piece. Removal of the lamina and spinous process allows the spinal cord to float backwards and gives it more room. Any tissue compressing the spinal cord is removed. If stabilization and fusion is planned, implants (screws) may be placed under C-arm guidance to impart spinal stability. Wound is closed in layers and a drain is kept for 1-2 days to prevent haematoma formation.
After the surgery, patient may be shifted to ICU for observation or to the room depending upon the medical condition.Patient is usually made to walk on the same/ next day. Normally, 3-5 days of hospital stay is required. Once medical condition is stabilized, patient has adequate pain relief and mobilized, patient is discharged.
Patient is asked to follow up for stich removal between 2-3 weeks from surgery. A waterproof dressing may be applied in some patients so that bath can be taken. Patient is required to follow up at 6 weeks, 3 months, 6 months, 1 years and then annually after surgery for examination. Based on serial x-rays and recovery – gradual increase in activities is advised.
Specific complications:
Occasionally, one of the nerves in the neck can be stunned after surgery because of the movement that occurs when the nerve moves back to its normal location after removal of the compression. This nerve “stunning” is called a nerve palsy. This palsy can cause significant weakness, especially in the shoulder, and pain in same region. Fortunately, this palsy is most of the times temporary and gets better without any treatment.
If stabilization is not done, in a few patients, post-operative Kyphotic Spinal Deformity may develop in a few patients.
Disclaimer: The description of procedure is how usually a surgery is done. During the procedure, based on intra operative encounters which varies from patient to patient different steps may be performed.