Posterior Cervical Decompression (Laminectomy/Laminoplasty)

Posterior Cervical Decompression (Laminectomy/Laminoplasty)

An operation to relieve cervical spinal cord compression through a posterior approach is called a laminectomy. Sometimes the removed bone is replaced after the decompression to reconstruct the spine, and the operation is termed laminoplasty. The less destructive laminoplasty may have a benefit in maintaining the normal anatomy of the cervical spine.

Do you need an operation?

Spinal Cord Compresssion (Myelopathy)

Compression of the spinal cord interferes with its function and may cause any of the following :

- weakness, clumsiness or stiffness of the hands (difficulty with fine movements - writing, buttons, feeding etc.)
- unsteadiness or stifness when walking
- numbness or altered sensation
- hyperactivity of the bladder

Compression may be due to :

- disc protrusion (also described as a herniation, bulge)
- ligament bulging or calcification/ossification
- bony spurs (osteophytes)
- mal-alignment of the spine (kyphosis, olisthesis)

Surgery aims to remove the pressure and tension on the spinal cord in order to prevent further damage. Improvement is often noted but not guaranteed.

The spinal cord is an extremely sensitive structure. Damage to the spinal cord is often irreversible. Surgery may not be able to reverse all symptoms. The primary aim of surgery is to prevent further damage. Surgery is therefore best performed when symptoms are mild, in order to prevent severe symptoms from permanent spinal cord damage.

The Operation

Laminectomy

You will be given a general anaesthetic so that you are unconscious throughout the procedure. An incision is made in the midline of the back of the neck. The muscles on either side of the spine are dissected from the spine and held to the side. An X-ray is used to confirm the correct level for the operation.

The bone at the back of the spine (spinous processes and lamina) is detached from the spine using a specialised high speed drill. Soft tissue and ligament holding the bone is divided and the bone removed. The dural sac containing the spinal cord is inspected and any remaining compression removed.

Laminoplasty

A decompression is performed using the same technique as laminectomy (described above). At the completion of the laminectomy, the removed bone (lamina and spinous processes) are replaced on the back of the spine and secured with small plates and screws. The spine is reconstructed to allow more room for the spinal cord.

At the end of the operation, local anaesthetic is injected to provide additional pain relief. The wound is closed with a dissolving suture under the skin. The general anaesthetic is stopped and you will wake up and be taken to the recovery room.

Risks of Surgery

Smoking and Surgery

Smoking is associated with higher risks of anaesthetic and more complications from surgery. There is a lesser rate of surgical success in smokers. Quitting smoking is a difficult process, but there are important benefits to be gained by quitting before surgery.

After Surgery

Going Home

With the use of modern techniques, many patients are able to go home within 3-5 days of the surgery. Before discharge, you will need to be able to eat and drink satisfactorily, walk short distances, perform basic self care and pass urine.

Early mobilisation and discharge is associated with quicker recovery and less complications.

Medications

Your pain should be controlled with oral medication alone. Constipation can be a side effect of some pain killers, so drink lots of water, eat a healthy. balanced diet and consider the use of stool softeners.

You should continue to take your normal medications as usual. Please discuss restarting 'blood-thinners' such as warfarin, clopidogrel (Plavix) or aspirin with Dr Ball.

Wound Care

Wounds are covered with a sterile dressing following the surgery. This can be removed 5 days after surgery. After this the wound can get wet in the shower.

Wounds are usually closed with dissolving stitches (sutures) under the skin. These wounds are reinforced with sticky (adhesive) strips on the skin. If they get wet, pat them dry with a towel and they will stay sticky. These can be removed after 5 - 7 days.

If staples or outside stitches are used, these can be removed 7 days following surgery by your local doctor.

Do not soak the wound (in a bath or pool) until you see Dr Ball after the surgery.

Please contact Dr Ball or your local doctor if the wound develops increasing redness or discharge, as this could suggest infection.

Activity Restrictions

For the first few weeks after surgery, the following activities must be avoided

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Gentle walking is the best activity to maintain fitness and health following anterior spine surgery. Gradually increasing to a daily 30 minute walk is a good goal.

Physiotherapy should only be started 4 - 6 weeks after surgery.

Follow-up

Dr Ball will see you about 6 weeks after the surgery. Following this you will have appointments at 3 months and 6 months following the surgery.