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Laminectomy and Spinal Fusion to Treat Cervical Myelopathy

Posted on: 12/21/2006
From time to time medical journals like The Spine Journal feature a single problem. In the November/December issue, the topic of cervical myelopathy (CM) is discussed in each article. In this article, surgeons from The Neurological Institute of New York review the use of laminectomy and fusion for CM.

Cervical myelopathy is a condition in which narrowing of the spinal canal in the neck puts pressure on the spinal cord and spinal nerves. Without treatment, patients can suffer severe neck and arm pain. Other symptoms such as numbness, tingling, weakness, and clumsiness are common. The legs can even be affected.

Laminectomy is the removal of bone from along the back of the vertebra. This takes the pressure off the neural tissue and is called surgical decompression. Laminectomy at multiple levels is usually followed by fusion of the spine to stabilize it.

The steps in the decision-making process include:
  • Should surgery be done at all?
  • Is the patient a good candidate?
  • What's the best surgery for the patient and the problem?
  • Should the operation be done from the front (anterior approach) or from the back (posterior approach) of the spine?
  • Is more than one level involved?
  • Can the operation be done all at once or are several staged procedures needed?

    The authors focused the rest of the article on the advantages and disadvantages of the posterior approach. This method takes less time, has fewer problems, and is easier for the surgeon. Obese patients with short necks are less likely to have swallowing, breathing, or talking problems with a posterior approach.

    There are some problems with the posterior approach. Sometimes patients have more pain afterwards compared to the anterior approach. This occurs because the nerves and blood vessels to the muscles along the spine are cut. Loss of muscle strength and bulk and a change in the curve of the spine can make the back of the neck look deformed.

    The authors provide other surgeons with a step-by-step description of a multilevel laminectomy and fusion. Photographs and diagrams help illustrate what to do and how to do it. Plate and screw placement are included. X-rays and more diagrams are used to show the final result.

    And last, but not least, a lengthy discussion of possible problems and what to do about them is included. Studies report favorable outcomes with this treatment. Patients who had poor results were usually older (more than 70 years old) with severe CM.

  • References:
    Ricardo J. Komotar, MD, et al. Surgical Management of Cervical Myelopathy: Indications and Techniques for Laminectomy and Fusion. In The Spine Journal. November/December 2006. Vol. 6. No. 6S. Pp. 252S-267S.

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