Cervical - Cervical Laminectomy, Fusion - Instrumented

A cervical laminectomy removes the spinous process and lamina from a vertebra to eliminate pressure on the spinal cord. The source of the pressure is often spinal stenosis, a condition in which there is a narrowing of the spinal canal that causes pressure on the spinal cord or nerves. After removing bone, bone grafts can be added to fuse the vertebrae and provide stability to the spine.

Introduction
A cervical laminectomy removes the spinous process and lamina from a vertebra to eliminate pressure on the spinal cord. The source of the pressure is often spinal stenosis, a condition in which there is a narrowing of the spinal canal that causes pressure on the spinal cord or nerves. After removing bone, bone grafts can be added to fuse the vertebrae and provide stability to the spine.

Incision & Removal
An incision is made along the midline at the back of the neck. After the spine is exposed, surgical instruments are used to remove the spinous process and lamina from the affected vertebrae. Another variation of this step involves using a motorized instrument to cut a trough through the lamina on both sides of the vertebra and removing the lamina and spinous process as a single piece. A surgical microscope is often used during this procedure to ensure a high degree of accuracy.

Preparing for Fusion
A motorized instrument (bur) is used to remove the top (cortical) layer of the articular processes (spine joints) at the sides of the vertebrae to prepare a site for fusing the vertebrae. The fusion will stabilize the spine where bone was removed.

Graft Placement
Bone grafting can be done with pieces of a patient’s own bone (autograft), processed bone from a bone bank (allograft), or a bone graft substitute (demineralized bone, ceramic extender, or bone morphogenetic protein). When a patient’s own bone is used for grafting, the pieces are typically crafted from the bone components that were removed previously (local bone graft). Bone grafts are placed along the prepared site where the top layer of bone was removed. This bone eventually grows in place, fusing the spine and providing additional stability.

Summary
The incision is closed and dressed to complete the procedure. A cervical collar is often worn for 6 weeks following surgery. Patients should be careful to avoid heavy lifting and excessive neck motion during recovery.