Cervical Laminectomy

As with other posterior decompression procedures, laminectomy treats compression of the spinal cord in the neck — from bone spurs, thickened ligaments, or a narrow canal — that is causing, or threatening to cause, myelopathy, with effects on the hands, balance and walking. When the compression involves several levels and comes largely from behind, removing the bony arches to decompress the cord can be considered. The main additional consideration is how to maintain the neck's alignment once the arches are removed.

Cervical laminectomy is carried out from the back of the neck. The bony arches (laminae) over the compressed levels are removed, along with any thickened ligament, opening the canal and relieving pressure on the cord. Because removing the laminae can affect the stability and alignment of the neck, laminectomy is often combined with a fusion — using screws and rods to hold the spine in good alignment — particularly where several levels are treated or where alignment is a concern. The decision to add fusion is based on the number of levels, the alignment, and the stability of the neck.

Laminectomy, usually with fusion, can be considered for multilevel cervical myelopathy or canal narrowing where the compression comes largely from behind. It is a versatile approach for several levels and is often chosen where alignment needs to be secured at the same time as decompression. Laminectomy without fusion is used more selectively, because of the recognised risk of the neck bending forward (post-laminectomy kyphosis) afterwards. The choice between laminectomy with fusion, laminoplasty, and anterior surgery is individualised.

The evidence guides how laminectomy is best used. Studies have documented the risk of kyphotic deformity after laminectomy alone, which is a major reason fusion is commonly added, and meta-analyses comparing laminectomy with fusion against laminoplasty show that both can achieve good neurological improvement, with differences in motion, alignment and specific complications. Large prospective series confirm that decompression improves myelopathy overall. The balanced view is that laminectomy — most often with fusion — is an effective, well-established treatment for suitable multilevel cord compression, with the technique chosen to protect alignment and stability.

The operation is performed under general anaesthetic, usually with a hospital stay of a few days. The aim is to relieve pressure on the cord and, where fusion is added, to secure good alignment; neurological recovery typically occurs gradually over months. Rehabilitation supports recovery, and where a fusion is performed the neck is held stable while it consolidates. As with any operation there are risks, which are discussed fully beforehand. The best approach for a given person is decided together.

• —Kaptain GJ, et al. Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 2000. (PMID 11012049)
• —Yuan W, et al. Laminectomy and fusion versus laminoplasty for multilevel cervical myelopathy: systematic review and meta-analysis. Eur Spine J 2017. (PMID 27342611)
• —Avetisian H, et al. Laminoplasty versus laminectomy and posterior fusion for cervical myelopathy: meta-analysis of radiographic and clinical outcomes. Global Spine J 2024. (PMID 38764362)
• —Bartels RHMA, et al. Long-term clinical and radiological follow-up after laminectomy for cervical spondylotic myelopathy. Eur Spine J 2016. (PMID 26543671)