Cervical laminectomy is a surgical procedure to alleviate pressure on the spinal cord, or as a treatment for the effect of degenerative disease on the neck (the 'cervical spine'). It involves the removal of the lamina and spinous process, the rear section of the vertebra.
Cervical foraminotomy procedure itself involves the removal of a smaller section of the lamina and the adjacent facet joint and other tissue that may be causing the compression of an individual nerve. It is generally carried out at the same time as the cervical laminectomy if it is required.
The types of conditions that can be treated with these procedures include...
- Spinal stenosis in the cervical section.
- Foraminal stenosis.
- Cervical spondylosis.
- Disc prolapse.
- Spinal cord compression from tumour, or degenerative changes.
- Injury / trauma.
Surgery is often recommended only when other non-surgical treatments, such as physical therapy, injections or pain medication have been exhausted. In some cases, where there is a neurological issue or where degenerative disease/s are already well advanced, surgery may be the only suitable treatment.
Before all neurosurgical procedures, including the procedure for cervical laminectomy / foraminotomy, you should…
- Be “Nil by mouth” meaning having nothing to eat or drink after midnight before the procedure. Medications can be taken with small sips of water.
- Inform your doctor about blood thinners that you may be taking – you will need to stop taking these at least a few days before your procedure.
- Non-steroidal anti-inflammatory medication (NSAIDs) may need to be stopped at least one week ahead of the procedure.
- Dental treatment (within three weeks) or any other form of surgery (within three months) of the planned procedure may need to be postponed.
- If you develop any symptoms of infection, e.g. a cold or flu, before surgery, or if you are receiving treatment for an infection, please inform us as soon as possible.
Cervical laminectomy and foraminotomy are performed under general anaesthesia. The patient lies face down, with the head held in a frame. Depending on the number of neck levels required, a 5-10 cm vertical incision is made to the midline of the back of the neck. The verterbrae are then exposed by moving the neck muscles aside. Using surgical instruments including rongeurs and a high speed drill, the laminae on the affected vertebrae are removed. This relieves the pressure on the spinal cord ('decompression').
At this point, a foraminotomy may also completed – this is where nerve roots that are under pressure are identified and decompressed by removing the facet joints, and other tissue such as, for example, bone spurs and thickened ligaments.
After this is completed the muscles and soft tissue are moved back into place and the incision is closed using absorbable sutures.
In some cases, an additional procedure known as a 'spinal fusion' may need to be performed to give the spine additional support.
After this procedure most patients will require pain medications, as this can be quite a painful operation. Sometimes, a soft neck collar will be helpful. Generally, admission in hospital for 2-4 days is required.
Full recovery from the procedure normally takes around three months, during which time you may need to attend physical therapy sessions. Most patients undergoing this procedure are able to drive a vehicle within 1-2 weeks, undertake light activities by week four and take up physical activity/sport again within again 2-3 months.
As with any surgical procedure there are potential risks and complications. With this procedure the main risks include…
- Anaesthetic risks.
- Damage to nerves and spinal cord.
- Spine instability (including post-laminectomy kyphosis).