Cervical Laminectomy & Foraminotomy

Cervical Laminectomy

A cervical laminectomy is a surgical procedure that involves the widening of the spinal canal by removal of the lamina, which releases pressure over the spinal nerves and/or the spinal cord. The lamina is a small bony plate covering the spinal canal. Narrowing of the spinal canal may occur due to any of the following reasons:

• Wear and tear of the spine with age
• Degenerative changes leading to spinal stenosis
• Excessive and repetitive stress or strain on the spine causing disc collapse
•  Herniated disc and bone spur formation can cause the compression of spinal canal

Procedure

Cervical laminectomy involves the following steps:

• The procedure is conducted under general anaesthesia.
• The patient is placed face down, on the operating table.
• X-rays images are used to identify the location of the incision.
• An incision is made through the skin, in the middle, on the back of the neck.
• The muscles are retracted with the help of a retractor.
• A surgical microscope is employed to magnifying the view of the area being operated.
• During laminectomy, only partial cutting of the lamina is done on one side, since complete removal of the laminae involves the loss of the facet joints and may cause a forward inclination of the spine.
• This partially cut lamina forms a hinge like structure and relieves the pressure over the spinal cord.
• Soft tissues present around the spinal nerves are carefully removed with small cutting instruments.
• Any bone spurs or intervertebral disc fragments present near the nerves are also removed.
• These surgical interventions help in relieving the pressure over the spinal nerves.
• Finally, the muscles and soft tissues are repositioned and the wound is sutured.

Post-operative care

Patients are usually discharged on the same day of the surgery and can resume driving within 1-2 weeks of the surgery. General post-operative instructions for a patient after a cervical laminectomy include:

• Use of soft neck brace

• Keep the incision clean and dry
• Move the neck with care and comfort
• Patient can get back to work after 3-4 weeks
• Avoid heavy work or any sport for at least 2-3 months
• Physical therapy is recommended for the strengthening of the weak muscles

Risk and complications

There are always some complications associated with any major surgery. Some of the complications associated with lumbar laminectomy include infection, spinal nerve injury, persistent pain, instability of the spinal fragments, and thrombophlebitis.

Cervical Foraminotomy

Cervical foraminotomy is a decompression surgical procedure that involves the widening of the neural foramen, the space through which the spinal nerve roots pass. The widening of the foramen helps in relieving pressure over the spinal nerves due to compression at the foramen.

The compression of spinal nerves in the foramen may occur because of degenerative changes in the spine that causes development of bone spurs which may lead to foraminal stenosis. Nerve compression can also result from a disc collapse caused by excessive strain and stress in the neck area.

Procedure

The basic steps of cervical foraminotomy include:

• The procedure is conducted in an operating room with the patient under general anaesthesia.
• The patient lies face down, on the operating table.
• An X-ray is used to identify the location of the incision.
• A small incision is made over the middle of the neck, at the back.
• The muscles are retracted (moved aside) with the help of a retractor.
• A surgical microscope is employed to magnify the view of the area being operated.
• Specially designed cutting instruments are then used to remove bone spurs, thickened ligaments and segments of the herniated disc.
• Removal of the bones and tissues around the neural foramen also releases the compression over the nerve roots.
• Finally, all the muscles and the soft tissues are placed in their appropriate positions and the wound is sutured.

Post-operative care

Patients are usually discharged on the same day of the surgery and can resume driving within 1-2 weeks. General post-operative instructions for the patient after a cervical foraminotomy include:

• Use of soft neck brace

• Keep the incision clean and dry
• Move the neck with care and comfort
• Patient can return to work after 3-4 weeks
• Avoid heavy work or any sports for at least 2-3 months
• Physical therapy is recommended for the strengthening of the weak muscles

Risks and complications

Every major surgery is associated with complications. Some of the complications associated with cervical foraminotomy include:

• Complications related to anaesthesia
• Conditions such as thrombophlebitis
• Infection
• Spinal nerve damage
• Persistent pain