Micro Discectomy / Laminectomy

Cervical Microdiscectomy :: Cervical Laminectomy

Cervical Microdiscectomy

Your spine consists of 24 bones called vertebrae that are arranged one above the other and separated by intervertebral discs which act as shock absorbers during activity. Your neck or cervical area is made up of seven of these vertebrae. The intervertebral discs consist of 2 parts, namely annulus fibrosus (outer flexible ring) and nucleus pulposus (central soft jelly–like region). The discs can be damaged due to wear and tear or a sudden injury to the spine, and is termed herniated disc. In this condition, the nucleus of the disc pushes against the outer annulus fibrosus and pinches the cervical nerves of the spinal cord that pass through these bones, causing pain in the arm. Cervical microdiscectomy is a surgical procedure performed to treat herniated discs in the cervical region.

Procedure

The surgery is performed under general anesthesia. During the surgery, you will be lying on your stomach. An X-ray is taken to determine the exact location of the herniated disc. The back of your neck is cleaned and a small incision is made. The muscles are carefully separated to gain access to the damaged disc. A part of your spinal lamina and facet joint (bony prominences of the vertebrae) are removed to expose the nerve root. Your doctor then uses a microscope to view the herniated disc under the compressed nerve, and excises the herniated region of the disc. The muscles are released and the incision is stitched close.

Recovery

After the surgery, you may be able to return home on the same day. You can gradually start daily activities and can return to work 1 to 2 weeks after the surgery. Your wound area should always be kept clean and dry until it heals.

Risks and complications

One of the major risks of cervical microdiscectomy is the possibility of recurrence of the herniated disc. There is also a risk that the remaining portion of the disc may collapse and compress the spinal nerves. The other possible risks of this procedure include damage of the nerve root or spinal cord, unresolved pain, infection or bleeding.

Cervical Laminectomy

A cervical laminectomy is a surgical procedure that involves the widening of the spinal canal by removal of the lamina, which releases pressure over the spinal nerves and/or the spinal cord. The lamina is a small bony plate covering the spinal canal. Narrowing of the spinal canal may occur due to any of the following reasons:

Wear and tear of the spine with age
Degenerative changes leading to spinal stenosis
Excessive and repetitive stress or strain on the spine causing disc collapse
Herniated disc and bone spur formation can cause the compression of spinal canal

Procedure

Cervical laminectomy involves the following steps:

The procedure is conducted under general anesthesia.
The patient is placed face down, on the operating table.
X-rays images are used to identify the location of the incision.
An incision is made through the skin, in the middle, on the back of the neck.
The muscles are retracted with the help of a retractor.
A surgical microscope is employed to magnifying the view of the area being operated.
During laminectomy, only partial cutting of the lamina is done on one side, since complete removal of the laminae involves the loss of the facet joints and may cause a forward inclination of the spine.
This partially cut lamina forms a hinge like structure and relieves the pressure over the spinal cord.
Soft tissues present around the spinal nerves are carefully removed with small cutting instruments.
Any bone spurs or intervertebral disc fragments present near the nerves are also removed.
All of these surgical interventions help in relieving the pressure over the spinal nerves.
Finally the muscles and soft tissues are repositioned and the wound is sutured.

Post-operative care

Patients are usually discharged on the same day of the surgery and can resume driving within 1-2 weeks of the surgery. General post-operative instructions for a patient after a cervical laminectomy include:

Use of soft neck brace
Keep the incision clean and dry
Move the neck with care and comfort
Patient can get back to work after 3-4 weeks
Avoid heavy work or any sport for at least 2-3 months
Physical therapy is recommended for the strengthening of the weak muscles

Risk and complications

There are always some complications associated with any major surgery. Some of the complications associated with lumbar laminectomy include infection, spinal nerve injury, persistent pain, instability of the spinal fragments, and thrombophlebitis.