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PATIENT GUIDE TO CERVICAL LAMINECTOMY (WITH OR WITHOUT FUSION AND INSTRUMENTATION)
This is a guide to the upcoming operation on your neck. You have a condition called cervical spinal stenosis. “Cervical” refers to the upper part of the spine where you have problems. “Stenosis” refers to a narrowing of the spinal canal that has reached such a critical level that the spinal cord and is being compressed. The symptoms of spinal cord compression include aching, numbness/tingling, weakness, and clumsiness of the arms and/or legs. You may also have issues with your balance or walking. The operation to relieve this is called a cervical laminectomy. During the operation, often with the use of the microscope, we use a natural opening to enter into the spinal canal. We shave down calcium deposits and remove the thickened ligament to relieve the pressure on the spinal cord. If there is a weakness or instability associated with your spinal canal narrowing, an additional part of the procedure includes securing the spinal bones (vertebrae) to one another to, in effect, make one bone.
PREPARATION: You will be asked to shower using a special soap, the night before or the morning of the surgery. It will be given to you by the hospital at your pre-operative evaluation. You should not eat or drink anything after midnight before the day of the surgery. You will be instructed if you need to stop any medications prior to your surgery by our office staff, and which medications to take the morning of your procedure, by the nurse at your pre-operative appointment.
THE PROCEDURE: When you come into the Operating Room, you will first enter the Holding Area. You will meet the nursing staff, the anesthesia staff, and have an intravenous placed. From there you will be moved to the Operating Room and be given medication that will allow you to drift off to sleep. You will remember nothing of the surgery.
After you are asleep, you will be rolled gently onto your belly. We will use a special frame that will secure your head to the bed, as there cannot be any motion of the head or neck during the surgery. After the correct level of your spine is identified by x-ray, a small incision will be made. A small amount of muscle is moved aside in order to expose the back of the spine (see picture above).
The operation is straightforward. We use a natural opening in the spine to enter the spinal canal. Specially designed instruments allow us to shave down calcium deposits and remove any thickened ligament from inside the spinal canal, to restore it to its normal size and to unpinch the spinal cord.
If it was determined that there was a weakness or instability in your spine, the next step will be to place small screws and rods, to secure the unstable level(s). To ensure that the bones are secured to one another throughout your lifetime, bone is placed that will grow from one vertebra to the other, creating a strong bridge that will last forever. The material that is placed is a combination of your bone that we had removed earlier in the procedure, and a special material to stimulate bone growth. In essence, the bones will grow together to make one bone.
The final step in the procedure is the closure. The muscle is repaired and the skin is closed, either with a surgical glue or with stitches.
AFTER THE SURGERY: When you awake, you will be in the Recovery Room. You can expect anywhere from mild to very unpleasant pain in the neck, across the shoulders, and in between the shoulder blades. This pain will slowly improve over the next several weeks. Most patients will remain in the hospital and go home in the following 1-2 days. While we want you to be home as soon as possible, we also want the procedure to be as safe as possible.
BENEFITS AND RISKS: The benefit of the surgery is to open up the spinal canal and unpinch the spinal cord. The main goal of this is to prevent any further worsening of your preoperative symptoms. Only about 50% of patients notice an improvement in their symptoms. The probability is that the spinal cord has already been damaged, but there should be no further worsening of your symptoms. With that, many patients do improve, either immediately or over a prolonged period of time. The recuperation from the surgery itself, with the healing of the muscles, occurs over the first 6 weeks or so. The spinal cord will continue to heal over the following 6-12 months. It is important to know that this operation is generally not effective for the relief of neck pain. Neck pain is the result of arthritis and tight muscles. This is something that a conservative approach with medication and conservative therapy is often beneficial for.
In regard to risks, it is a generally safe procedure. Given the narrowness of the spinal canal, the possibility exists for a spinal injury with weakness or paralysis of the arms and legs. In the medical literature the incidence of this is about 1%. The more reasonable concern is infection and spinal fluid leakage. Infection is a risk of all forms of surgery, and in this case it is approximately 1%. This is usually treated with oral antibiotics. The spinal cord is covered by a membrane that can be very thin in these conditions. If we find a small hole in the membrane as a result of the procedure, spinal fluid can leak out. We repair the hole at the time of surgery. This usually heals quickly, without any need for further treatment. Bleeding is another risk of surgery. Although there are major blood vessels that run along either side of the spine, the risk of significant blood loss is less very low. We generally lose a few tablespoons of blood during the procedure. The risk of your body not healing the bones, screw pull-out, or screw/rod breakage, is extremely low.
You will see me before the operation, in the Holding Area, to answer any questions. You will then be seen by the physician assistant in the hospital. Your postoperative appointments will occur at approximately 2 weeks and 6-8 weeks after surgery. Physical therapy will be started after the 2 weeks visit, if needed. Either the physician assistant or I are always available, 24 hours a day, 7 days a week, if there are any questions or concerns after your surgery.