Posterior Cervical Laminectomy and Fusion

1. Surgical exposure: Dr. Colman will make a 3–4 inch incision in the back of the neck (posterior) and will carefully move the muscles to the side without damaging them. This allows visualization of the bones and spinal nerves.
2. Posterior Cervical Laminectomy: Dr. Colman will remove the lamina, which can be thought of as the roof that covers the spinal canal. By removing the lamina, he creates more space within the spinal canal, reducing pressure on the spinal cord and nerves. The goal is to restore spinal cord function, improve symptoms and eliminate weakness, numbness and coordination.
3. Spinal Fusion: After the laminectomy, the spine may be unstable due to the removal of bone and other structures. To address this, a spinal fusion is performed. This involves the placement of bone graft and screw/rod implants between the affected vertebrae. The bone graft is typically a combination of the patient’s bone and a synthetic protein graft substitute. Some degree of spinal re-alignment is possible during this step. The goal of fusion is to encourage the vertebrae to grow together into a single, solid bone, stabilizing the spine and preventing movement between the damaged, affected segments.

Posterior cervical laminectomy and fusion is typically indicated in cases where the patient has severe, multilevel spinal cord compression and a preserved or normal “arch” in the neck. Some very specific conditions such as ossification of the posterior longitudinal ligament are commonly treated using this technique. Additionally, the patient should have failed conservative treatments such as physical therapy, medications, or injections. Common conditions treated with this procedure include:

• Cervical myelopathy: A condition where spinal cord compression leads to neurological deficits such as weakness, numbness and difficulty with coordination. This is most commonly due to degenerative causes such as arthritis or disc herniation.
• Ossification of the posterior longitudinal ligament: A condition where a spinal ligament gets very thick and turns to bone, causing spinal cord compression.
• Tumors or other growths: Abnormal masses may place pressure on the spinal cord or nerves.

Recovery from a posterior cervical laminectomy and fusion can vary depending on the extent of the surgery and the patient’s overall health. Initially, patients may experience pain and limited mobility, but physical therapy usually helps in regaining strength, motion, and function. This is because much of the neck’s motion comes from the top of the spine at the skull, C1, and C2 joints which are not commonly included in the fusion. The fusion process itself can take about three months, during which the vertebrae grow together. However, healing can take up to a year after surgery.

Most patients experience significant relief from symptoms like pain, numbness, and weakness after the surgery. However, as with any major surgical procedure, there are potential risks and complications, such as infection, bleeding, nerve damage, or issues related to the fusion not healing properly.

Patients are typically advised to follow post-operative instructions carefully, which may include wearing a neck brace, avoiding strenuous activities, and attending regular follow-up appointments to monitor the fusion process.