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Neurology (Expert Forum)
Laminectomy or Laminoplasty
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Laminectomy or Laminoplasty
by stemath, Jun 27, 2004 12:00AM
I am a 52 year old male who had a lumbar laminectomy at L4-L5-S1 5 years ago without fusion due to a ruptured disc. My neurosurgeon wants to do a 4-level cervical laminectomy from C3-C7 due to osteophyte formation and spinal stenosis. He will do the surgery posteriorly without fusion. He does not do laminoplasty as he feels it is untested. We are still unsure that the cervical stenosis is causing my recent leg weakness and increased constipation issues, so I have put off the surgery until more lumbar testing is done, including EMG/NCV tests. My neurologist feels the cervical stenosis is not causing the problems and I do not yet present with substantial hand or arm weakness or neck pain, though there is a little at times. Results of two lumbar MRIs in the past three months indicate no major changes except for scar tissue and a slight herniation at L3.
Is it common to do a four level posterior cervical laminectomy without fusion? What is the failure rate (or success rate) of such a surgery, meaning how often does such a surgery have to be followed up later with fusion? What is your feeling about laminoplasty vs. laminectomy for such a case? Would I be wise to find another neurosurgeon who does laminoplasty?
Is it common to do a four level posterior cervical laminectomy without fusion? What is the failure rate (or success rate) of such a surgery, meaning how often does such a surgery have to be followed up later with fusion? What is your feeling about laminoplasty vs. laminectomy for such a case? Would I be wise to find another neurosurgeon who does laminoplasty?
Doctor's Answer
by CCF-Neuro-M.D.-CS, Jul 06, 2004 12:00AM
Sorry for the delay, I wnated to clarify something before answering your question. Without looking at your scans, I can not determine which type of surgery you require. However, if the spinal canal stenosis is due to hypertrophic changes in the bone, then laminectomies may increase the canal space, and may be sufficient. If there is any instability in the vertebral bodies, then fusion may be necessary. It is difficult to comment on laminoplasty. Most of our surgeons do not perform this, but that does not mean that some patients may benefit from this. What I would recommend is to have this completely evaluated before proceeding to surgery. If there is still a question, a consultation at an academic spine center would be preferable. Good luck, and sorry for the delay.
On 4/26/04 on advice of his neuro surgeon, he had a posterior laminectomy from C-2 through C-7 (with no bone grafts) because of stenosis, arthritis and bone spurs and to relieve pressure on spinal cord. Dr. said he needed surgery in case of additional falls which would further damage spinal cord. After this surgery, he never regained his strength and in addition has had periods of unexplained weakness and "episodes of decompensating where he cannot walk without assistance, sit up in bed without assistance, etc. His general condition has been deteriorating since the laminectomy.
In mid-July, he started having problems walking which eventually became so bad his right leg became paralyzed. He was finally diagnosed with a slipped disk in lower back, and surgery was performed in mid-July 2004 to decompress the disk. The slipped disk was above the fusion area. He received in-patient PT & OT after back surgery, walking with a brace on his right leg. His strength seemed to be returning - until 8/13/04.
Prior to his 2/16/04 fall, he had been diagnosed with degenerative disk disease throughout his spine and in 2001 (after 2 failed lower back surgeries) had a "flexible fusion" of his lower back. This surgery was a god-sent and helped my husband regain a reasonably normal life, without pain or medications, prior to his fall in 2004.
Also he has coronary artery disease and has had 3 angioplasties. After the fall and after the laminectomy, he was fitted with a pacemaker because doctors said his heart rate was too slow. Some doctors feel the low heart rate caused the fall (to pass out) but there is no evidence pro or con to support this idea. However, this does not now allow neurologists to perform MRIs to view his cerival or lumbar areas.
Question: What is the chance the periods of unexplained weakness or episodes of regression are caused by the further disk degeneration or movement in the cervical area or a similar neurological problem? After each episode, he never seems to regain his strength totally, so the result has been continued deterioration. What other things could be causing this?. He was scheduled to be discharged from in-patient care today, but over weekend had an episode of regression - extreme weakness, inability to walk, sit up in bed, etc. To make matters worse, he fell last night trying to get out of hospital bed into bathroom. It took 3 nurses to get him up. He sustained a bump on head and hopefully no other injuries.
Sorry for the lengthy recitation but wanted to give you enough facts.