Posterior Cervical Decompression (Laminectomy) and Fusion

Posterior Cervical Decompression (Laminectomy) and Fusion

An operation to relieve cervical spinal cord compression through a posterior approach is called a laminectomy. If the spine is considered unstable, the bones must be held together with metal screws and rods with bone graft, and the operation is termed fusion. This operation may occasionally be performed in combination with an anterior operation.

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.

Fusion

A decompression is performed using the same technique as laminectomy (described above). Screws are placed in the remaining bone on either side of the spine (lateral mass/pedicle). There are normally two screws at each level (one on the left and one on the right). A rod is placed to connect the screws on each side.

Bone graft is placed around the screws to allow fusion to occur. The bone removed in the laminectomy is normally used as bone graft. If this is insufficient, a bone substitute or bone growth protein may be used or additional bone taken from your pelvis or the bone bank.

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. Fusion is more likely to fail in smokers because of bone graft 'rejection'. 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 5-7 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

A cervical collar (neck brace) may be prescribed after your surgery. Instructions will be given about how and when to wear it.

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.