Posterior cervical decompression, or cervical laminectomy, is one of the oldest spinal surgical techniques that is still frequently utilised. The operation involves the removal of the posterior components of the spinal arch in order to provide additional room for the spinal cord within the cervical spinal canal. The most common cause for compression of the spinal cord is a consequence of degenerative changes affecting the joints and ligaments of the cervical spine. A number of options have been devised in order to best achieve the required decompression without adversely affecting the structural integrity of the cervical spine. Trauma, infection and tumours of the cervical spine can also be managed with variations of this procedure.
The patient is positioned prone on an operating table with protective support for the torso and the head is secured in position using a three-point fixation clamp. A posterior midline incision is made spanning the intended surgical levels that are marked with the assistance of pre-operative x-ray screening. The neck muscles are separated off the posterior components of the bony vertebral arch to expose the posterior aspect of the vertebral column.
The correct surgical level is confirmed with the assistance of intra-operative x-ray. The spinous processes and lamina of the vertebra are removed utilising a selection of instruments. The specific technique selected for this purpose depends on the patient’s spinal anatomy and the degree of decompression required. A high-powered surgical microscope is often used to ensure optimal surgical safety during the decompression of the neurological structures.
The need for posterior cervical fusion as an adjunct to the decompression depends on pre-operative assessment of spinal anatomy and alignment and the intra-operative assessment of the spinal stability following the decompression surgery. The fusion can be facilitated with or without instrumentation (surgical implants), depending on individual requirements.
Once the surgeon is satisfied with the decompression, spinal stability and haemostasis the posterior muscle layers are closed over a small-bore wound drain. The skin is closed with resorbable sub-cuticular sutures and covered with an appropriate dressing.
Preparing for Surgery
Ensure that you know what surgical procedure you are having. It is important to understand the reasons for the operation as well as having a realistic expectation of the outcome. If you have any questions regarding your operation please do not hesitate to discuss these with Dr Crispin Thompson.
Ensure that you have received authorisation from your medical aid, including the authorisation number. Different medical aid providers and medical aid plans offer different levels of cover for surgical procedures. It is your responsibility to know what services are covered by your particular medical aid plan, including whether any co-payments are applicable.
Refrain from eating and drinking anything from 02h00 on the morning of your surgery, unless specifically instructed by one of our team members. Patient specific recommendations will be made depending on your specific circumstances.
Present yourself to the Mediclinic Milnerton reception area by 06h30 on the morning of surgery. You will be admitted onto the hospital administrative system by a member of the reception team before being shown to your bed on the ward. You will need to bring your identification document, your medical aid card and number and your authorisation number with you to the reception area.
Bring all your medication with you to the hospital so that the necessary in-hospital prescriptions can be accurately and appropriately formulated. The medication will need to be given to the ward nursing staff when you are admitted to the ward prior to surgery.
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