Cervical Laminectomy & Fusion is a surgical procedure used to relieve pressure on the spinal cord and nerves in the cervical spine (neck) by removing the lamina (the back part of the vertebrae) and fusing adjacent vertebrae to stabilize the spine. This procedure is often performed to treat conditions such as cervical stenosis, myelopathy, or significant spinal cord compression caused by degenerative disc disease, herniated discs, or bone spurs.

Why Choose Cervical Laminectomy & Fusion?

Cervical Laminectomy & Fusion is typically chosen when there is significant spinal cord or nerve compression that has not responded to conservative treatments such as physical therapy, medications, or injections, or where there is evidence of progressive spinal cord dysfunction. This procedure not only decompresses the spinal cord and nerves but also stabilizes the spine, preventing further degeneration or deformity.

What Happens During Cervical Laminectomy & Fusion Surgery?

Preparation

• Hospital Admission: You will be admitted to the hospital on the day of surgery. Fasting is required before the procedure, as directed by your anaesthetist.
• Anaesthesia: The surgery is performed under general anaesthesia, ensuring you are asleep and pain-free throughout the procedure.
• Spinal Cord Monitoring: Spinal cord monitoring leads will be attached once you are asleep to enable real-time monitoring of the health of the spinal cord and nerves for your safety
• Urinary Catheter: A catheter is placed to monitor your fluid status.

Surgical Approach

• Patient Positioning: You will be positioned face down (prone) on the operating table to allow access to the back of your neck. Your head is secured with a specialised frame which anchors your scalp using some pins.
• Incision: A midline incision is made in the back of the neck over the affected vertebrae. The muscles and soft tissues are carefully moved aside to expose the lamina. The correct disc level is localised using intraoperative X-rays.

Laminectomy Procedure

• Lamina Removal: The lamina from the affected vertebrae are removed using specialised tools to create more space for the spinal cord and nerves. This decompression relieves the pressure that is causing pain, weakness, or numbness.
• Removal of Bone Spurs or Disc Material: If necessary, A/Prof Buckland may also remove bone spurs or disc material that is contributing to nerve compression.

Fusion Procedure

• Bone Grafting: Bone graft material (either from your body, a donor, or synthetic) is placed between the vertebrae in the facet joints, which will be prepared for fusion at the levels where lamina was removed. This graft material promotes the fusion of the vertebrae, creating a solid bridge of bone.
• Implants: Metal implants, such as screws and rods, are used to stabilize the vertebrae while the fusion takes place. These implants help maintain proper alignment and prevent movement between the fused vertebrae until the bone graft produces a solid fusion mass.

Closure

• The surgical site is carefully closed with sutures, and a sterile dressing is applied to protect the wound. The muscles and tissues are repositioned to minimize the risk of complications. A drain is typically placed to prevent blood or fluid from collecting around the spinal cord and to protect the wound.

Long-Term Outlook

• Symptom Relief: Many patients experience significant relief from symptoms such as neck pain, arm pain, and neurological deficits following cervical laminectomy & fusion. Recovery of symptoms of chronic spinal cord damage are difficult to predict and often incomplete. The specifics should be discussed with A/Prof Buckland at your preoperative visit.
• Range of Motion: Cervical Laminectomy & Fusion results in some loss the range of motion in your neck. The amount of motion loss depends on the number of fused levels and the amount of arthritis remaining at the non-fused levels.

Postoperative Care and Recovery

Hospital Stay

• Most patients stay in the hospital for 3 days following cervical laminectomy & fusion surgery, depending on their recovery progress and overall health.

Pain Management

Pain is managed with medications, and early mobilization is encouraged to reduce the risk of complications such as blood clots or pneumonia. Some stiffness and discomfort in the neck are common in the first few days following surgery.

Rehabilitation

Physical Therapy: A rehabilitation program will be initiated shortly after surgery, focusing on restoring mobility and self-care initially, and later strength, and function. Physical therapy is crucial for achieving the best possible outcome.

Activity Restrictions: A neck collar will be prescribed and will likely need to be worn for the first 6 weeks. You should avoid heavy lifting, twisting, and overhead activities for approximately 3 months after surgery. A/Prof Buckland’s team will guide a gradual return to normal activities.

Follow-up

Follow-up appointments will be scheduled, typically at 2 weeks, 6 weeks, 3 Months, 6 Months, and 12 Months after surgery. X-rays are obtained at all of these visits other than 2 weeks post-surgery.

Risks and Complications

As with any surgery, there are potential risks, including:

• Infection: There is a risk of infection at the surgical site.
• Bleeding: Excessive bleeding during or after surgery is possible.
• Nerve Injury: There is a risk of injury to the spinal cord or nerves, which could result in weakness, numbness, or other neurological symptoms. Spinal cord monitoring will be used to reduce the chance of spinal cord or nerve damage.
• Non-Union: In some cases, the bones may not fuse as expected, potentially requiring additional surgery.
• Adjacent Segment Disease: The segments above and below the fused area may experience increased stress, leading to future degeneration.