IntroductionA posterior cervical laminotomy / foraminotomy is performed to remove pressure off of one or more nerve roots by enlarging the space where the nerves exit the neck.
This less invasive procedure commonly is used to treat certain types of cervical disc protrusions, cervical disc herniations, and foraminal stenosis.
Success rates for relief of arm pain generally falls in the 80-90% range for the appropriately selected patient who undergoes posterior cervical laminotomy / foraminotomy surgery.
This procedure can be performed on an outpatient basis for many patients.
As with any surgical procedure, there are potential risks and benefits that should be discussed and considered.
Description of ProcedureThis surgery is performed under general anesthesia. Once you are comfortable and asleep, you will be positioned on your stomach. Live x-ray is used to localize the area of your incision.
A small incision will be made along the posterior (back) side of your neck. Using specialized retractors, the surgeon will develop a plane through layers of muscle that will allow access to the affected area. Once the correct level is confirmed, using a high speed drill, small fragments of bone and ligament will be removed to uncover to individual nerve root(s).
The tunnel where the nerve travels (neural foramen) is then enlarged (foraminotomy). Any fragments of disc or bone spurs are also removed.
Any muscles that were split at the beginning of the procedure are stitched back together and the skin is closed with staples.
The advantage of this approach is that it can alleviate radiating pain into the arm(s) without the need to fuse bones together.
For a one or two level procedure, this is expected to be an outpatient procedure. If you are having three or more levels operated on, this would be performed at the hospital in which you would stay for at least 1 night. If your pain level is tolerable and you are doing well medically, you can expect to be discharged.
You will leave the hospital or surgery center with a soft cervical collar. This is provided for your comfort. You may take this off when you wish. We encourage you to wear it for the first week, especially when outside the home or if you are having spasms.
No, it is against the law to drive a motor vehicle with a cervical collar on. You will need to wait until the collar is removed before you may drive.
While everyone’s pain tolerances and conditions differ, most recover from this type of surgery within a 4 to 6 week time period.
This depends on the type of work you perform and the duties involved. In general, most patients can return to a sit down type job with no lifting required within approximately 2 weeks after surgery. Those patients who have heavier duty occupations requiring lifting, pushing, pulling, and overhead activity can expect to be out 4-6 weeks.
Most patients can return to driving within 10-14 days after surgery. Please keep in mind that if you are taking narcotic pain medication and/or wearing a cervical collar, you should not drive a motor vehicle.
Your incision is closed with skin staples. A Silverlon dressing will be placed over the surgical incision. This should be left on until your first post-operative visit with Dr. Shim. If it begins to fall off, please contact the office.
As a normal part of the post-operative period, we encourage you to get up and walk shortly after your surgery. You may walk as much as you can tolerate.
At the time of your first post-operative visit in the office with Dr. Shim, you will be instructed to begin gentle range of motion exercises for your neck. Most patients are able to do their own therapy at home and do not require a formal therapy program.
Staples will be removed 12-14 days after surgery.
Yes, you may resume sexual activities as soon as you feel up to it. This may be a few days or even a week after you come home from the hospital. You should avoid positions which cause increased neck discomfort.
Most patients are free to travel after their initial post-operative visit 12-14 days after surgery. Patients who may have been experiencing any problems during this time may be encouraged to wait a little longer before traveling. Keep in mind, you will not be able to carry any heavy luggage greater than approximately 10–15 pounds for the first 4 weeks after surgery. For international patients who are considering this surgery, please see our program schedule for returning home.
You may take a bath upon your return home, but you should avoid getting your neck and head wet. Most patients can safely resume a normal bath 3 weeks after surgery.
One of the benefits of the Silverlon dressing is that you may get it wet. You may begin showering the second day after surgery. We encourage you to turn your front side to the shower head to avoid the water saturating your dressing.
A stool softener will be ordered for you while in the hospital. You may discontinue this after your first bowel movement or at your discretion.
Yes, in approximately 3 weeks after surgery. The incision needs to be completely healed before you swim.
Everyone’s pain tolerances and conditions do vary. In general, many patients experience some relief of their arm symptoms immediately after surgery. It is not uncommon to have neck soreness, stiffness, and incisional discomfort for several weeks beyond surgery. For some patients, the pain level may decline slowly over weeks or even months after surgery.
Several reasons for this. First, you were given medications to help relax you and your pain during the surgery along with the anesthesia. This combination of medications may stay in your system for a day or two after surgery. Secondly, as you start feeling better, most patients become a bit more active, this can lead to increased discomfort initially.
A sore throat can result from anesthesia in some cases. You received an endo-tracheal intubation (“tube”) into your throat to help you breath during the procedure. This may have irritated the lining of your throat. This soreness and even some difficulty swallowing tends to resolve within a few weeks after surgery.
If you experience any fevers over 101.5 degrees, any wound drainage, swelling or redness around your surgical incision, increasing pain, tingling or numbness that you did not have before surgery, difficulty swallowing, difficulty walking, severe headaches, difficulty urinating or weakness, call your doctor.
You can lift up to 5 lbs. after surgery until your first post-operative visit. After 12 – 14 days, Dr. Shim will allow you to gradually increase your ability to lift.
RisksSome of the risks and complications associated with this procedure include:
- Wound infection
- Nerve injury including paralysis
- Loss of bowel or bladder function
- Blood clots
- Numbness (temporary or permanent)
- Scarring of the nerve(s)
- Recurrent disc herniation/protrusion
- Incomplete relief of symptoms
- Risks associated with anesthesia
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