Spine Surgery

What is a posterior cervical laminectomy and lateral mass fusion?

A posterior cervical laminectomy is a type of spine surgery that can be performed with or without a lateral mass fusion.

A posterior cervical laminectomy or cervical laminectomy, is a procedure that a neurosurgeon performs through the back of the neck. It aims to relieve any pressure on the spinal cord or nerves by removing a portion of the bony roof of the spinal canal, known as the lamina. A neurosurgeon may remove other structures causing compression, such as overgrown facet joints, bony spurs and herniated discs, during this operation.

A patient may need to have a cervical laminectomy with our without a lateral mass fixation/fusion if they are diagnosed with spinal conditions such as cervical spinal stenosis, cervical myelopathy or spinal trauma.

The laminae and facet joints play an important role in stabilising the spine and preventing vertebrae from slipping. Sometimes when a neurosurgeon removes multiple laminae and facet joints to relieve pressure on a patient’s spinal cord, or corrects forward bending (kyphosis) of the cervical spine, they will then fuse the patient’s vertebrae as a lateral mass fixation/fusion to ensure the affected area maintains its steadiness.

How does a neurosurgeon perform a posterior cervical laminectomy?

A neurosurgeon will begin a posterior cervical laminectomy by making an incision (5-7cm) down the middle of the back of a patient’s neck. They will then carefully separate muscles attached to spine, with care being taken to preserve the muscle fibres.

Once the bony roof of the lamina is properly exposed, a neurosurgeon will carefully remove it with a combination of instruments. This will increase the space surrounding the spinal cord, freeing it from compression. They will also remove any soft tissue causing compression and free any compressed nerve roots by removing potentially compressive structures.

How does a neurosurgeon perform a lateral mass fusion?

If a patient requires a fusion, their neurosurgeon will use metal implants, including screws and rods, to fix the vertebrae in place. Their neurosurgeon will also employ a bone graft to create a bridge between each vertebra. They will fix screws to solid, bony structures on each side of the vertebral bone known as the ‘lateral masses’ (hence why the procedure is called a ‘lateral mass fixation/fusion). This will help to ensure stability and strength in a patient’s cervical spine.

A medical team will take an X-ray to confirm the position of the rods and screws, and the alignment of a patient’s vertebrae. After this, a neurosurgeon will close the wound with self-dissolving sutures. They will place a dressing over the wound. In some cases, a patient may be given a wound drain for one to two days after surgery.

To learn about other types of spine surgery, select from the list on the right-hand side of the page.


Sources

  1. Levin K, Aminoff MJ, Wilterdink JL. Cervical spondylotic myelopathy. UpToDate, Retrieved Aprilie 2013;9:2015
  2. Rhee JM, Basra S. Posterior surgery for cervical myelopathy: laminectomy, laminectomy with fusion, and laminoplasty. Asian spine journal 2008;2(2):114-26
  3. Robinson J, Kothari M. Treatment and Prognosis of cervical radiculopathy. UpToDate, Shefner, J.(Ed), UpToDate, Waltham, MA
  4. Baron EM, Young WF. Cervical spondylotic myelopathy a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery 2007;60(suppl_1):S1-35-S1-41
  5. Anderson PA, Matz PG, Groff MW, Heary RF, Holly LT, Kaiser MG, et al. Laminectomy and fusion for the treatment of cervical degenerative myelopathy. Journal of Neurosurgery: Spine 2009;11(2):150-6