Cervical Laminoforaminotomy

What is Cervical Laminoforaminotomy?

Cervical laminoforaminotomy is a spine surgery that is performed to relieve pain and weakness resulting from a pinched or compressed spinal nerve in the cervical (neck) region.

The spinal lamina is a thin, bony plate forming the roof of the spinal canal and the spinal foramen is a hollow opening through which spinal nerves run. Cervical laminoforaminotomy involves the removal of a part of the spinal lamina along with any obstructing disc fragments, bony fragments, or bone spurs to widen the foramen and alleviate pressure on the nerves.

Anatomy of the Cervical Spine

The spine, also called the backbone, plays a vital role in stability, smooth movement, and protection of the delicate spinal cord. It is made up of bony segments called vertebrae with fibrous tissue called intervertebral discs between them. The vertebra and discs form the spinal column from the head to the pelvis, giving symmetry and support to the body. The spine can be divided into 4 parts: cervical, thoracic, lumbar, and sacral region. The cervical spine comprises the first 7 vertebrae of the spinal column, which form the neck.

Indications for Cervical Laminoforaminotomy

Cervical laminoforaminotomy is usually indicated to treat a painful condition called cervical radiculopathy when conservative treatment measures such as physical therapy and medications have failed to relieve pain.

When a disc is herniated, either by a sudden traumatic injury or over time with age, the jelly-like center of the disc can “bulge” through and create pressure on the nerve root, and painful bone spurs can form as a result of arthritis in the neck. These compressed nerves in the neck can cause cervical radiculopathy, with symptoms that include radiating neck pain that spreads into the upper back and down the arms and hands.

Other conditions that may cause a pinched or compressed nerve in the cervical region, include:

• Spinal stenosis
• Sudden disc injuries
• Disc herniation
• Spinal arthritis
• Bone spurs
• Enlargement of the nearby ligament
• Spinal degenerative problems

Preparation for Cervical Laminoforaminotomy

Preoperative preparation for cervical laminoforaminotomy may involve the following steps:

• A review of your medical history and a physical examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work, urinalysis, and imaging to help detect any abnormalities that could compromise the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements that you are taking or any conditions you have such as heart or lung disease.
• You may be asked to avoid blood thinning medications such as aspirin for a specific period prior to surgery as they increase your risk of bleeding.
• You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
• You may be instructed to shower with an antibacterial soap the night prior to surgery to help lower your risk of infection after surgery.
• You should refrain from alcohol or tobacco at least a few days prior to the surgery and several weeks after as it can hinder the healing process.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You are advised to arrange for someone to drive you home after surgery.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Cervical Laminoforaminotomy

Cervical laminoforaminotomy can be performed using an anterior (front of the neck) or posterior (back part of your body) approach. The posterior approach is the preferred choice as it has shown better results in relieving foraminal nerve root compression. In general, the procedure involves the following steps:

• You will be placed on the procedure table in a face-down position under the influence of general anesthesia.
• Your surgeon makes a small incision on the symptomatic side of your neck and approaches the spine by bringing the neck muscles apart using a retractor.
• Your surgeon utilizes a burr and other specialized instruments to thin down or remove a part of the lamina (the bony arch that forms the backside of the spinal canal) to allow your surgeon better access to the tissues compressing nerve structures.
• Your surgeon then removes the bone, bone spurs, and tissues that are compressing the nerve root, thereby relieving the pressure on spinal nerve structures and creating decompression.
• If your compression is due to a herniated disc, your surgeon will remove the segment of the disc that is compressing the nerve, as well.
• The neck muscles are brought back to their original position by removing the retractor.
• The incision is then closed with stitches and the wound is covered with a bandage.

Postoperative Care and Recovery

Postoperative care instructions and recovery after cervical laminoforaminotomy may involve the following steps:

• Following surgery, your neck may be immobilized in a collar to protect the repair and promote healing.
• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover. 
• You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed for comfort.
• Application of cold compresses on the operated area is also recommended to reduce swelling and pain.
• Antibiotics are also prescribed as needed to address the risk of surgery-related infection.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• Avoid lifting, bending, or twisting your back and neck for the first 6 weeks. Do not lift anything heavier than 5 pounds for the first 2 weeks. Refrain from any strenuous activities such as exercises, housework, yard work, or sex for at least a month.
• A physical therapy regimen will be designed after a defined period to help strengthen the cervical spine area and optimize its function.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• You should be able to resume your normal activities in a couple of weeks but may have certain activity restrictions.
• Complete recovery and return to work vary from patient to patient as it is related to a patient’s age and health status and the type of work one does.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Cervical laminoforaminotomy is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

• Infection
• Bleeding
• Nerve injury
• Spinal cord injury
• Failure to relieve symptoms
• Dural tear (tear of the sac covering the nerves)
• Serious medical complications, such as stroke, heart attack, or lung problems
• Adverse reaction to anesthesia