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Any cervical laminoplasty, laminotomy, or foraminotomy folks out there??

scotto74sscotto74 Posts: 5
edited 06/11/2012 - 8:57 AM in Spinal Stenosis

Just wondering if anyone out there has had some sort of posterior cervical decompression surgery and how you are doing. I'm facing the prospect of some combination of these surgeries, and would love to connect with anyone who may have some experience in this area. I had a two-level ACDF (c5-7) in January of this year, and unfornately my symptoms have progressively worsened after a few months of relief.

I've now gotten several opinions and unfortunately, they are not converging at all in terms of how to address the congenital stenosis in my neck. Here's what has been recommended:

Surgeon #1 (my original surgeon) -- C2 - C7 laminoplasty & foraminotomy, posterior fusion at C5 - C7 (to secure my original fusion better) and an open rhizotomy on my bone-on-bone facet joint at C2/3 left

Surgeon #2 -- C5 - 7 laminectomy & fusion (with some foraminotomy) to address the worst area of compression. No need to go up higher.

Surgeon #3 -- C2 - C7 laminectomy & fusion (with foraminotomy)

I'm really wrestling between the recommendations of Surgeon 1 & 2 -- and unfortunately, both are convinced that the other's approach is absolutely incorrect. So I'm trying to understand the magnitude of my stenosis across each level better -- so I can hopefully decide whether or not it makes sense to be more aggressive now in terms of opening up the entire canal.

I'm also a bit concerned about laminoplasty in general, some of the inherent risks of the procedure, and whether or not it's truly any better than a laminectomy and fusion.

Unfortunately, my symptoms (leg heaviness/weakness, difficulty climbing steps, left arm weakness) are not getting better so I know that I need to move forward sooner than later.

Thanks for taking the time to read my post, and I hope everyone is doing well!



  • HI Scott,

    First let me say welcome to spine-health. Have a look around and you will find others whom have had both multiple surgeries and the posterior approach. Good to see someone doing their research and getting all the information up front. I have multiple surgeries and fused from c3-c7 with posterior surgeries. Several things come to mind when you discuss doing that many levels or not. First have they discussed your ROM(range of motion)? Not sure what you do for a living, but if you plan on going back to work this might play in if to many levels are fused. The obvious is you don't want to leave anything not taken care of and have to go back again. But when it comes down to spine surgery, more is not always better. Doing foraminotomies can open the space, but it depends on your what your issues are?

    Do you or do you know if you have myelopathy? If so what level is causing the issues? Also have they told you that once you develop the condition that surgery will only stop the progression but can't reverse it? The lami would help with that condition and might be why they are suggesting it? Both of the first two surgeons are suggesting it, using a different process.

    The one thing you should also know is that posterior surgery is a longer recovery than anterior surgery. I am taking it that you didn't fuse on the first surgery? If so what will they be using as a bone graft? If you didn't fuse I think it is important that you are using your own bone, as with multiple levels failure rates are higher on the fusion. Of course they can take from the illac, or grind up some of what they are taking out, and use in combination with BMP or just use BMP, or there is cadaver, but I wouldn't want to go that route on a second surgery. If you didn't fuse the gold standard is posterior surgery, to fuse it.

    Has your first surgeon offered any reasons as to why your first surgery went bad? If I was in your shoes I would put a toss a between 1 & 2 as you kind of have done. I would then choose one surgeon and go from there. If you really like your first surgeon but don't what all of what he is offering discuss with him/her and see if you can get some changes or why or why not, on how he/she is doing the surgery?

    Just thought I would stop by and welcome you to spine-health. If I can be of any help in the future don't hesitate to pm me. Take care and keep me posted.
  • In June 2011 I had an MRI and was told I had "severe" stenosis (ribboning) in C3-7 and need surgery asap. The term asap didn't bother me that much until the surgeon told me I would be paralized in 2-3 years due to the severity of the stenosis. We discussed both options anterior and posterior. If he went in through the front there would be screws, plates and loss of my range of motion. By going through the back I would keep my ROM and would have very little hardware. The surgeon stressed how much more pain I would be in and how much longer my recovery would take by choosing the posterior approach. I decided to get a 2nd opinion (my surgeon had no problem w/that, he highly recommended it). I work in a doctors office and a visiting Neuro-surgeon took a look at my MRI report (didn't tell him anything the other doctor had said), he asked "when is your surgery?"
    After thinking about it for a few weeks I decided to have the surgery-posterior. On August 25, 2011 I went into the hospital for my surgery. I was in the hospital for 3 days and in severe pain (thank goodness for the pain pump!) The most pain is in the first 2 weeks (pretty bad) I guess because they cut through so many nerves, muscles, ligaments,etc. by going through the back. I only wore the neck brace for about 2 weeks (was told I could take it off when ever I felt like I could) I couldn't drive for 2 weeks. But, on my 3rd week I drove 350miles down to Flordia to lay on the beach! I returned to work in 5 weeks (mostly at my desk). I have full range of motion, no more tingling in my hands/fingers (didn't know that was why before first visit to the doctor) and am doing pretty well. I did not have any arm/shoulder problems (which can happen and is one of the first things they ask after surgery). I still have unexpected muscle pains (shooting pains)and still have tightness and pain sometimes in turning my neck. But, all in all I think everything went very well. Find yourself a very good surgeon that you trust, my surgeon is excellent . I have another follow up next week which will be 2 1/2 months post-op.
    I do have one question...anyone else having any muscle cramps? Like "charlie horses" in your hip, calves or bottom of feet? Don't even know if its related, just asking.
    If asked: I'd do it again.

    Post edited by Tam doctors name removed.
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  • Hi tamtam, thanks for welcoming me to the board! I'm glad to be here (well, sort of) and will definitely look around to see if I can find some folks who have gone through similar procedures. I'm also looking forward to making some connections and being a part of the community.

    To answer your first question about work, I was in the investment industry and spent a good bit of my day behind a computer (which gets fairly painful now) and travelling 20% or so to visit clients, give presentations, etc. I definitely realize that a C2-C7 fusion will result in quite a good bit of loss of ROM. I know you lose some motion with a laminoplasty as well, but I'm guessing its not as constrained as a long fusion. Still, given the extent of my stenosis and osteophytes, I do worry about the effects of the laminoplasty on the levels above my current c5-7 fusion.

    As for the foraminotomies, I have had several EMG's that have revealed nerve compression and damage at the C5-7 level, primarily on the left side but also on the right to some extent I believe. So the surgeons I've spoken with mostly talked about doing some work around that level to give those nerves a little more room.

    I've been told that I have "some cord compression" still after my surgery, which is coming from the back of my neck and is the worst around the 6-7 level. My symptoms are deep, stabbing, aches and pain in my neck, weakness in my arms and hands (primarily left), and the more concerning symptoms are constant nerve pain in my upper thighs/groin area and the worst problem is heaviness/weakness in my legs that makes it difficult to walk up a flight of stairs at times. Lumbar spine checks out mostly ok, with some slight degeneration L5-S1, but nothing that could be causing my symptoms at this point. Going back to see a neurologist again today (fourth evaluation since my op) just to be completely sure there's not some other neuro-muscular type of disease causing my leg symptoms. I am fairly certain, however, that it's the compression in my neck -- as my leg heaviness and groin pain went away completely for the first few months following my ACDF.

    As for the posterior surgery, I'm definitely nervous about it and I've heard from multiple people and surgeons that it is a much more difficult and painful recovery. My ACDF surgery did use bone graft from my iliac crest, and they have no idea why I haven't completely fused. Healthy, non-smoker, good diet, stayed away from the NSAID's for at least 6 months, used a bone stim. The only thing that is interesting to me is that my brother had to have three neck surgeries due to failed fusions.

    Yeah, I definitely think I've narrowed it down to Surgeons 1 (my surgeon) and 2. However, their approaches are quite different and each thinks that the other is absolutely wrong. I like both surgeons, although I probably have a closer relationship with my current surgeon. However, my biggest concern is how much of the spinal canal should be decompressed at this point... that's where everyone seems to differ in terms of being more aggressive or more conservative. I like the idea of the c5-7 laminectomy and fusion surgery, however, my surgeon raises a big concern that the cord will drift backwards and given how tight my entire canal is, this will cause pressure (or the cord to kink) just above and potentially below the lami. Surgeon 2 says not to worry about the drift back and only address the levels of worst compression. Both make a lot of sense to me, and I guess I'm just trying to get to a point where it feels a little better than a coin flip in terms of what is the best longer term approach.

    Thanks again for the support and all of the thoughtful questions! I really appreciate it, and look forward to being an active part of this community.

  • Thanks for taking the time to share your story, sdover. Sounds like you made the right decision and are having a successful recovery so far!

    I've heard about the significant pain post-op. Definitely not looking forward to it, but I guess it's one of those things in life you just get through (and be thankful for the pain meds!). Just curious, were you having any symptoms of myelopathy prior to surgery and have any of these symptoms improved post-op? I noticed that after my first surgery my hands got stronger, nerve pain in the thighs and groin area subsided, my legs seemed to feel less heavy and I got up the stairs much better. Unfortunately that only lasted a few months.

    I know that c5 palsy is a risk during laminoplasty (and laminectomy as well, I believe, not sure though) so I'm glad to hear you did not experience any of those complications post-op. This is an odd question, but does your neck "feel" a lot different with the laminoplasty? I asked my surgeon what it would "feel" like to have the lamina opened like that, and obviously he can't really say. Also, I wonder what impact the laminoplasty with have on my other levels (which are arthritic and degenerating) and he said he also couldn't really say.

    With that said, I do really trust him and I think he's a great surgeon. It's great to hear about a positive laminoplasty case, so thanks again for sharing!

  • scotto74
    You know I'm not really sure what pains and problems were coming from my neck I had been "masking" it for years (pain meds). I have noticed things like I'm not tingling in my fingers/toes anymore. My neck doesn't seem to hurt as bad (still having a little post-op pain though). I did tend to walk sideways a lot and stumbled a good bit which I just thought was clumsiness! That seems to be much better also.
    As far as the way my neck "feels"..a little wider maybe. Really you cannot see any difference except my 5-6" scar. The scar it's self looks great but it itches like crazy! All of my upper back area itches and it's "inside" where you cannot scratch (ha-ha)! I don't feel any different as far as.. It doesn't protrude & I don't squeak when I turn my head either(lol).
    Have faith in your surgeon and God and all will be well!
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  • Hey everyone, just checking in and hoping to get any input that might help in my incredibly painful decision-making process. So I'm set to have the C5-C7 laminectomy and fusion (plus some foraminotomy work) next week, and I'm unfortunately still agonizing about whether or not it is the right decision. I've already postponed this surgery once (with this surgeon), and I'm sure he would be livid (not to mention I would basically sever the relationship I'm sure) if I were to back out at this point. So here's what's keeping me up at night...

    On one hand, I think this surgery directly addresses my most prominent problems most directly -- failed fusion and slight cord compression around the C6-7 level mostly, as well as minor nerve issues along the left side, also primarily around C5 - C8. In addition, a surgeon at Hopkins who I really liked alot seemed to endorse this approach over either the C2-7 laminoplasty (plus c5-7 fusion) or the C2-C7 laminectomy and fusion.

    However, what keeps me up at night is the fact that three other surgeons (including the one who did my original ACDF) have said that you can't only decompress the C5-7 level -- that there's stenosis (although not cord compression) at pretty much every level in my neck, and if you only decompress the c5-7 level, the cord will drift back and essentially become kinked at the junction just above the decompression. Both the surgeon I am scheduled with and the Hopkins guy said I didn't really need to worry about the "drift back" issue as my worst compression is at the c5-7 levels.

    So my question is, has anyone ever heard of anyone having a partial laminectomy and fusion (as opposed to a C2-7 or c3-7) and then subsequently having to go back in for more surgery either b/c of incomplete compression or b/c the cord drift caused a subsequent problem??

    Also, I do really trust my original surgeon -- the one who is proposing the C2-C7 laminoplasty with a C5-7 fusion -- however, this surgery just seems really complex to me. Has anyone ever heard of a combination of laminoplasty and fusion?? A couple of the docs I consulted with called that proposal "insane" (or some variation of that), which basically scared me away from going with the original guy... as much as I really like and trust him.

    Well, that's the update for now.. and if anyone has any quick thoughts they would like to share, I would be incredibly grateful!

  • Hi,Scott:

    I had the cervical laminaplasty surgery on March 26, 2012.

    I was diagnosed with cervical myelopathy with central stenosis and all the fun that goes with that condition. I was unable to function as a professional firefighter and barely able to perform adminstrative functions (day shift). I was continuing to degenerate to the point where I would be disabled if nothing was done. This had gone on for a couple years and all I thought I had was a sore neck, until I started losing the use of my hands and right leg, among other problems.

    The surgery was an amazing success. I immediately regained use, function, and sensation of my hands and right leg. I had to relearn how to walk as I had been compensating so much for the deficits. C3-C7 was opened up, cadaver bone was implanted along with titanium straps and screws to hold everything together, and voila!

    Recovery wasn't as bad as I thought it would be. The main challenge was allowing things to heal and not overuse my neck. I did experience pain, but nothing that was manageable. I am also dealing with a minor complication in that one nerve was stretched a little coming out of the C5 foramen, but the surgeon says that will resolve in a couple months.

    I will eventually return as a regular duty firefighter and just returned 6 weeks post-op on light duty.

    Don't let yourself suffer! I almost let this condition go too long to the point of major nerve damage and disability.

    My surgery was performed at Harborview Medical Center/UW Hospital, Seattle, WA under the direction of Dr.EDITED. I totally vouch for him and his team. They saved me from a life of disability!

    Post edited to remove name of medical professional and or facility. by The Spine-Health Moderator Team
  • Hi,
    I'm looking at a laminoplasty in the very near future and would live to hear more about people's recoveries. I'm reading mostly positive remarks which makes me feel more confident about what I am heading into.

    What went well? What was challenging? How are you today? Any recovery and rehab tips! I'd especially like to know how long you had myelopathy symptoms ( if you did) before having the surgery.

    Thanks for the support!
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