Cervical stenosis causes narrowing of the spinal canal in the neck and can place pressure on the spinal cord, resulting in cervical myelopathy (neurologic deficits). If most of the spinal cord compression is in the back of the spinal canal, the condition may be treated with a surgical procedure called posterior cervical laminectomy.

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What Is Posterior Cervical Laminectomy?

This surgery is a type of cervical decompression that aims to create more space in the spinal canal by removing 2 bony structures at the back of the spine:

The spinous process: a prominent bony protrusion at the back of the neck
The laminae: a pair of small flat bones that extend from the left and right side of the spinous process

Removing these bony structures provides more room for the spinal cord by widening the spinal canal and allowing the spinal cord to heal.

The procedure may be performed on one or more spinal levels between C1 and C7.

Goals of the Surgery

Surgical removal of the lamina aims to accomplish one or more of the following goals:

Improve pain and neurologic deficits (myelopathy symptoms) in the neck, arms, hands and lower extremities.
Prevent the progression of myelopathy symptoms
Improve gait problems, such as loss of balance and reduced walking speed

This surgery preserves the natural range of motion of the neck.

When Cervical Laminectomy Is Recommended

As a first treatment option: for moderate to severe cervical myelopathy symptoms

After nonsurgical treatments: for mild cervical myelopathy symptoms that do not resolve and continue to progress

Unless a medical emergency (severe spinal cord compression), this surgery is elective, meaning that it is the patient's decision whether or not to have surgery.

Conditions Treated

Common indications for cervical laminectomy include:

Cervical stenosis with myelopathy
Ossification of the posterior longitudinal ligament (OPLL)
Cervical tumors and cancer
Epidural infections
Epidural hematoma

The procedure is beneficial in treating multilevel lesions, where decompression of more than one consecutive spinal level is needed.

Posterior Cervical Laminectomy Procedure Explained Step-By-Step

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The surgeon removes the lamina and spinous process to relieve compression on the spinal cord.

Posterior cervical laminectomy is an open surgery performed in an ambulatory surgery center or a hospital’s outpatient department.

The procedure is relatively short and includes the following steps:

Positioning and anesthesia: The patient lies face-down on the procedure table and general anesthesia is administered.
Surgical approach: A 3 to 4-inch-long incision is made in the midline of the back of the neck. The para-spinal muscles are elevated – or moved aside – to access the spinous process and lamina.
Removal of the spinous process and laminae:
- A high-speed burr (bone-cutting tool) is used to make a trough in the lamina on both sides right before it joins the facet joint.
- The laminae with the spinous process are removed as one piece (like a lobster tail). Removal of the laminae and spinous process allows the spinal cord to float backward and gives it more room.
Closing: After the surgery is complete, the muscles are reapproximated and the incision is closed with suture.

The anesthesia is stopped, and the patient is moved to a recovery room where his or her vital signs are monitored for about 4 to 5 hours.

Discharge Considerations

Most patients can return home the same day or the next day after surgery. A longer hospital stay may be necessary for patients who:

Have a history of bleeding disorders
Have difficulty breathing after the surgery
Have had prior cervical spine surgery in the same segment
Had multiple levels decompressed

A full list of activity restrictions and rehabilitation protocols will be reviewed with the patient before discharge.

What to Expect After Posterior Cervical Laminectomy Surgery

The results of a laminectomy are variable and depend on the severity of spinal cord compression, the length of time symptoms have been present, and the severity of myelopathy. Studies show that 42% to 92% of patients have favorable outcomes after the surgery.¹Ryken TC, Heary RF, Matz PG, et al. Cervical laminectomy for the treatment of cervical degenerative myelopathy. J Neurosurg Spine. 2009;11(2):142-149. doi:10.3171/2009.1.SPINE08725

Risks and Complications

As with any surgical procedure, there are risks of serious complications, but the incidence is rare.

Specific risks associated with this procedure are:

Neurologic deterioration after the surgery: worsening of spinal cord function due to trauma or manipulation of the spinal cord during surgery.
White cord syndrome: worsening of spinal cord function due to sudden reperfusion of blood into cells that have been severely compromised or compressed.
Post-laminectomy kyphotic deformity: an abnormal forward curvature of the cervical spine. This risk is higher with multi-level laminectomies.
Delayed neurologic deterioration: worsening of spinal cord function over time due to the development of kyphotic deformity or scar tissue formation.
Instability in the spinal column: the loss of posterior (back) support of the spinal column may cause uneven distribution of loads and instability in the treated segment(s).

Other general surgical risks include dural tears, infection, bleeding, and increased pain.

To help manage the risk of neurological deterioration due to surgical trauma, spinal cord function is often monitored during surgery by somatosensory evoked potentials (SSEP). SSEPs generate a small electrical impulse in the arms and legs, measure the corresponding response in the brain, and record the length of time it takes the signal to get to the brain. Any marked slowing in the length of time may indicate a compromise of the spinal cord.

Posterior Cervical Laminectomy with Fusion

Cervical laminectomies are sometimes combined with fusion surgery. The fusion procedure is performed to avoid the potential complications of instability and spinal deformity (kyphosis) associated with cervical laminectomy alone.

Fusion is achieved by placing rods and screws in the treated segment.

Laminectomy with fusion is recommended when one or more of the following factors is present²McAllister BD, Rebholz BJ, Wang JC. Is posterior fusion necessary with laminectomy in the cervical spine?. Surg Neurol Int. 2012;3(Suppl 3):S225-S231. doi:10.4103/2152-7806.98581:

Significant axial (localized) neck pain
Reduced lordosis (natural backward curve of the spine) or straightening of the cervical spine
Spinal instability in the neck

The combined procedure reduces neck mobility after the surgery and is associated with additional risks, such as degeneration of the adjacent segment, vascular (blood vessel) injury, nerve damage, and instrument-related complications.

Posterior Cervical Laminoplasty

Some spine surgeons recommend a procedure called laminoplasty – where the lamina is lifted on one side, and a hinge is created on the other side. The lamina is held in this hinged position with a metal plate and screws.

The potential advantage of this technique is that it increases the size of the canal but leaves the posterior bony support, which helps keep the spine stable. It also preserves spinal mobility in the neck.

The potential disadvantage is that the canal is not well visualized, and it is difficult to assess whether or not the canal has been adequately decompressed.

The choice between laminectomy, laminectomy with fusion, and laminoplasty requires a collaborative decision between the patient and their doctor and a thorough evaluation of the potential risks and benefits of each option.