“Cervical laminectomy?”
I've had neck/lower back pain for years after retiring as a paramedic. A neurosurgeon is now suggesting I get a 3 maybe 4 level Cervical Laminectomy without hardware. I have researched the procedure and now have more questions than answers. Here are my two pressing questions.
1. If the bone is removed from the back of the spine exposing the cord in three or four places what is protecting the cord on the posterior side from direct injury if accidentally struck or involved in an auto collision?
2. If no hardware will be used for fixation and the tendon is severed which provides back and front motion stability what is the possibility of permanent forward head droop which could become a disability in itself.
1. If the bone is removed from the back of the spine exposing the cord in three or four places what is protecting the cord on the posterior side from direct injury if accidentally struck or involved in an auto collision?
2. If no hardware will be used for fixation and the tendon is severed which provides back and front motion stability what is the possibility of permanent forward head droop which could become a disability in itself.
Male | 60 years old
Complaint duration: 10+ years
Medications: Lyrica, Tramadol as needed
Conditions: Mod/Severe Spinal Stenosis
1 Answer
You have asked two important questions. The first one is more easily answered. Although you are correct, that a multilevel cervical laminectomy removes the bony protection to the spinal cord, injury to the cord after laminectomy is extremely rare. In fact, I have never heard of it. Your second question though is more important and more difficult to answer. The main stability of the cervical spine is the intervertebral discs and the facet joints. The lamina and the attached muscles and ligaments provide only a minimal part of the cervical spine's stability BUT if the facets are removed or weakened during the laminectomy procedure then the spine may become unstable and assume a "swan neck" deformity. The most important question, however, that you did not ask is: what is the indication for a multilevel cervical laminectomy? You only mentioned neck pain, but laminectomy is not indicated for only neck pain. Multilevel cervical laminectomy is usually done to treat spinal stenosis with symptoms of spinal cord compression such as leg weakness or spasticity, loss of sensation in the legs, and bladder or bowel problems. It is also sometimes done for multilevel cervical radiculopathy although anterior discectomy with or without fusion is probably a better option for that condition. I suggest that you ask the neurosurgeon who recommended the procedure to answer these questions, and also inquire about the indications for the recommended procedure.
