In somewhat older age groups (50+), due to disc degeneration, multiple discs can bulge and/or herniate, and the ligaments can buckle into the spinal cord or nerve roots resulting in spinal stenosis (pinching of not only the nerves down the arm, but the spinal cord itself). Cervical stenosis can place pressure on the spinal cord. The result of pinching of the spinal cord can be an insidious loss of coordination, loss of balance during walking, and even bowel and bladder incontinence.

If most of the compression is in the back, this condition can be treated with a posterior laminectomy. The objective of this procedure is to remove the lamina (and spinous process) to give the spinal cord more room. The spinal cord is especially sensitive to injury, and once the progression of pinching leads to significant loss of function, this function may not be reversible even with removal of the offending agent(s).

In the figure at right, the spinal cord (blue) is shown being compressed at multiple levels in the cervical spine by the discs from the front and the ligaments from the back (yellow). The spinal cord looks like an hour-glass in the areas in which it is compressed.

1. Surgical approach
• The skin incision is in the midline of the back of the neck and is about 3 to 4 inches long
• The paraspinal muscles are then elevated off of the lamina.



2. Removal of the lamina
• A high speed burr can be used to make a trough in the lamina on both sides right as it joins the facet joint.
• The lamina with the spinous process can then be removed as one piece, or can be removed piecemeal.
• Removal of the lamina and spinous process allows the spinal cord to float backwards and gives it more room.

Cervical Fusion
Cervical laminectomies are sometimes done with a cervical fusion. If a posterior laminectomy is done without a cervical fusion, there is a post-operative risk of developing instability that may lead to pain and deformity. Therefore, there is a risk that a fusion will be needed at some point in the future.

Posterior Laminoplasty
In order to reduce the risk of post-operative instability and to avoid a fusion, some surgeons will recommend lifting the lamina on one side and leaving a hinge on the other side (posterior cervical laminoplasty).

• The advantage of this technique is that it increases the size of the canal but leaves the posterior tether that helps keep the spine stable.
• The disadvantage is that it may not be as easy to decompress the nerves on both sides as they exit the foramen.