Cervical laminectomy is a time-tested form of spinal surgery that is usually used to treat central spinal stenosis, but can also be used to treat other conditions including foraminal stenosis, ligamentous ossification and hypertrophy and even severe disc pathologies. Laminectomy now comes in many procedural variations ranging from traditional rear open incision placement to fully endoscopic and laser-assisted versions.
All types of laminectomy seek to accomplish a primary goal of removing part of the dorsal spinal bones in an effort to access the interior of the spinal canal and treat some form of pathological process contained therein. Laminectomy is typically rated highly on the level of invasiveness, even when performed in minimally invasive versions, since it actually changes the structure of the backbone by removing tissue. Hence, recovery is usually a painful and protracted process that often requires extensive rehabilitation postoperatively.
This report focuses on cervical lamina removal surgery. We will explain the indications for this particular type of surgical treatment, explore the procedure itself and provide expert evaluation of the technique to help patients decide if this operation will best serve their specific treatment requirements.
Goals of Cervical Laminectomy
Lamina removal surgery is usually used in cases of central spinal stenosis, where the spinal canal must be accessed to remove stenosis blockages that might consist of osteoarthritic formations, possibly compounded by herniated discs or intervertebral fragments, as well as ligamentous hypertrophy or ossification conditions. In many cases, the foraminal openings are also treated in order to remove arthritic accumulations that threaten individual nerve root egress from the central canal.
In this regard, laminectomy is both effective and versatile, allowing a surgeon to gain entrance to the interior of the spinal canal by removing the rear sections of vertebral bones. This is advantageous if the surgeon expects to find more than one source of stenosis within the canal or discovers previously unknown causative factors during the course of the procedure.
Laminectomy in the neck is the second most common location for the technique to be utilized, only beaten by application of the procedure between L4 and S1 in the lower lumbar spine. This is expected, since these are the most common regions for spinal stenosis and foraminal stenosis to occur due to the stresses inherently placed on the backbone in the mid to low neck and low lumbar zones.
Laminectomy Procedural Variants
Laminectomy can be used as a stand alone surgical technique or might be combined with other procedures in order to best achieve the treatment goal and subsequently repair the damaged spine. When used as the sole procedural technique, laminectomy can treatment spinal stenosis due to many different possible sources. However, by adding discectomy, foraminotomy, facet joint trimming, spinal fusion or corpectomy, the surgeon facilitates treating virtually any possible condition or set of conditions that are deemed responsible for creating the symptoms.
When combined with discectomy, lamina removal allows intervertebral tissues to be treated at the same time as arthritic stenosis in the central and foraminal canals. Removing multiple levels of lamina will allow treatment at more than one location, such as at C4/C5 and C5/C6 concurrently.
When combined with foraminotomy, the neuroforaminal openings can be widened in order to increase the patency of these spaces and eliminate pressure on compressed nerve roots.
In cases where surgical damage to the anatomy is deemed to be severe, the spine might become unstable and might require reinforcement using a spinal implant, spinal fusion or corpectomy technique. All of these variations are fraught with risks and are the techniques known to create the ideal circumstances for postoperative complications. Therefore, they are best avoided when possible, although they make the procedure far more profitable for the doctor.
Lamina removal itself can be accomplish using fully open or minimally invasive surgical practices, as can the possible add-on procedures detailed above. It is always in a patient’s best interests to undergo the least invasive form of the operation that can successfully attain the objective of treatment, in order to reduce healing time, increase postoperative comfort and mitigate the many risks of more damaging surgical techniques.
Cervical Laminectomy Evaluation
Laminectomy surgery in the neck is usually better tolerated than similar surgical endeavors in the lumbar spine. Recovery is typically faster and slightly less painful according to the most recent patient statistics. However, the procedure is still very damaging and will require the use of powerful pain medications during recovery, as well as the implementation of physical therapy to regain full functionality.
As far as effectiveness, cervical laminectomy has the potential to fulfill virtually all surgical objectives successfully, but this relies on positive alignment of many often difficult to predict factors including:
The diagnosis of the actual cause of pain must be accurate or the treated conditions within the spinal canal might not be the actual symptomatic origin. We see this travesty constantly and report that this is the single most prevalent reason for poor procedural outcomes in treated patients.
The surgeon must not make any mistakes, since the incidence of iatrogenic complications poses a high risk with this operation. The occurrence of scar tissue formation, nerve or spinal cord damage and other complications can all happen due to surgical negligence or error.
Additional procedures added to the lamina removal technique substantially increase the risks. Discectomy is known to work well, but leaves the intervertebral tissue prone to re-herniation. Meanwhile, spinal implants, fusion and corpectomy are the most complication-ridden techniques in the entire surgical arena. Additionally, fusion and corpectomy also hasten the future deterioration of the backbone, most often resulting in follow-up surgeries as the spine degenerates at an alarming rate.
We have been very critical of lamina removal procedures in some of our past articles, simply because there are newer and less invasive options to treat virtually all of the conditions that are targeted using laminectomy. However, when the surgeon actually needs to access the interior canal directly, there is no better approach than the one offered by cervical laminectomy. This being said, we always advise finding an expert in its application and choosing the least invasive form of the procedure that is available in order to maximize the chances for positive and lasting results.