Patients should be aware that a laminectomy, particular when performed with back surgery fusion, can take a long time to recover from and will require extensive physical therapy to regain their pre-surgery level of mobility. More minimal procedures, such as a laminotomy, or laminoplasty usually have shorter recovery times, and are more appropriate for some patients who already have a degree of spinal curvature, for example. Laminectomy in the cervical spine can be particularly troublesome in terms of pathological curvature development. Damage to the facet joints during the procedure can also cause the spine to tilt forward and contribute to degeneration. Laminoplasty can help prevent this occurring but it is more difficult to assess the level of decompression achieved during this type of surgery compared to a laminectomy.
Whilst the increased lordosis of the spine can effect relief from back pain and neurological symptoms, some patients may find that it worsens or contributes to postoperative nerve root palsy (Chen, 2009). A laminectomy does not prevent the continued degeneration of the spine and further problems may require further surgery at a later date. If surgery is performed without fusion then the stability of the spine may be compromised, particularly if the facet joints were damaged during the procedure or the patient already had spinal curvature (Houten, 2003).
Sciubba (2008) conducted a study of ten years of clinical cases of laminectomy without fusion in patients who required the procedure for a dural tumor resection. Among the observations were a propensity for those having a three (or more) level laminectomy to require fusion surgery at a later date; approximately 33% of patients in this group required additional surgery after two years or so, compared to approximately 5% of those undergoing laminectomy on two levels or less.
General Surgical Risks
The general risks of surgery are present, such as thrombophlebitis, anaesthetic complications, blood loss, and risk of infection. Blood thinning medication, surgical stockings, and prompt movement to get circulation going after surgery are possible recommendations for those undergoing this operation in order to reduce the risks of deep vein thrombosis. Spinal surgery confers further risks due to the delicate nature of the area in which the procedures are carried out, and surgeons take great care to avoid damage to the nerves, blood vessels, muscles, ligaments, spinal cord, and bony structures in the area. The cervical spine presents further risks due to the location of the thyroid gland, larynx, and several major blood vessels and nerves.
It is possible that a tear in the spinal cord or nerve root may occur during surgery, with a resulting leak of spinal fluid. In a cervical laminectomy the acute presence of breathing difficulties can indicate a problem with the spinal cord as the diaphragm is controlled by cervical spinal nerves. An emergency tracheostomy may be performed to ensure respiratory function remains intact. The risk of this being required is very low. Damage to the laryngeal nerve can also cause problems with both the voice, swallowing, and breathing with the potential for a degeneration of function after surgery or an initial issue connected to nerve trauma and short-term inflammation.
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