Cervical Laminectomy | Posterior Cervical Fusion

An Overview of Cervical Laminectomy, Laminoplasty and Posterior Cervical Fusion

Cervical laminectomy, laminoplasty and posterior cervical fusion are procedures performed in the back of the neck. The incision in the rear of the neck will expose the lamina and facets and allow the surgery to extend down into the thoracic spine. These anatomic areas have great utility for certain conditions.

The lamina is the roof of the spinal canal. The spinal canal houses the spinal cord. If there is compression of the cord, unroofing the canal will allow the spinal cord to drift backwards and give the cord more room to prevent compression. This is called a laminectomy (“ectomy” means to remove in Latin). This is a simple surgery to perform but has some consequences to understand. If the spine has developed a degenerative kyphosis (a curve backwards from the normal lordosis curve) which is not uncommon with degenerative changes causing cord compression, the laminectomy has limited value. The cord needs to be able to drift back enough from the crowded spinal canal and the abnormal curve may not let this happen.

Cervical Laminectomy & Laminoplasty

The laminoplasty is a procedure similar to the laminectomy, but instead of removing the lamina, the lamina is enlarged to allow more room for the spinal cord. The procedure is technically more demanding as the lamina must be partially cut, stretched and then fixed in its new position with a bone graft and a small titanium plate at each level. The usefulness of this procedure is similar to a laminectomy (cord compression and myelopathy) but may give more stability to the operated segments than a laminectomy can. Of course, the repaired lamina must heal in a laminoplasty and there is no healing required in a laminectomy.

In either procedure (cervical laminectomy, laminoplasty and posterior cervical fusion), there is a danger to the C5 nerve roots, not from the technical aspects of surgery but from the new displaced position of the cord. As noted above, the spinal cord should “drift” backwards with a successful laminoplasty or laminectomy. Of course, the nerve roots are attached to the spinal cord. The cord drifting back will by definition, stretch the nerve roots somewhat. The shortest and least easily stretched roots are the C5 roots that attach to the deltoid muscles (the shoulder muscles that raise and lower the humerus- the upper arm bone). Occasionally, there may be weakness of these muscles after surgery but they normally recover after a period of time. There are rare times that some weakness can be permanent.

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Posterior Cervical Fusion

Posterior cervical fusion is as the name implies, fusing the back of the neck. This procedure can be used because of fracture, deformity, pseudoarthrosis (lack of successful fusion in the front of the neck- ACDF) and to extend a fusion down to the thoracic spine. Since a fusion requires immobilization to work, screws, rods and wires are typically used. Bone graft is then placed along the facets and normally, within 3 months, a solid fusion occurs.

A posterior fusion can be used in conjunction with a laminectomy to decompress the spinal cord or a foramenotomy to decompress a nerve root (see section on posterior cervical foramenotomy for further description of that procedure).

To learn more about cervical laminectomy, laminoplasty and posterior cervical fusion as a treatment option for spine related conditions, please contact Dr. Donald Corenman, spine surgeon and neck doctor offering diagnostic and surgical second opinions to patients in the USA and around the world.

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(Click to Enlarge Image) Preoperative lateral x-ray of the cervical spine. The black double arrow notes the reduced diameter of the spinal canal causing compression of the spinal cord.

(Click to Enlarge Image) Post operative XP x-ray of the laminoplasty. Please note that the spinous processes (noted by the white lines) are “off center” in the area of surgery as the back wall of the canal that the spinous processes attach is rotated to the side to open the canal.

(Click to Enlarge Image) Post-operative lateral x-ray of the laminoplasty. The black double arrow notes the enlarged canal. Compare to the pre-operative x-ray.

(Click to Enlarge Image) Post operative CT myelogram of the laminoplasty. The black arrow points to the spinal cord and the white arrow points to the CSF. Note that the spinal cord is surrounded by CSF which means there is no compression of the cord.

Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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Cervical Laminectomy, Laminoplasty and Posterior Cervical Fusion

An Overview of Cervical Laminectomy, Laminoplasty and Posterior Cervical Fusion

Cervical Laminectomy & Laminoplasty

Are you a candidate for Cervical Laminectomy, Laminoplasty or Posterior Cervical Fusion?

Posterior Cervical Fusion

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About the Author: Donald Corenman, MD, DC