I'm searching for any information I can find about neck fusions. I had a laminectomy at four levels about two years ago. Now the spine is starting to collapse in that area. My neck curve is starting to reverse itself so the surgeon is advising fusion. Can a surgeon really put my neck back in place and will it stay there?
In a laminectomy, a portion of the vertebral bone (the lamina) is removed to take pressure off the spinal cord. Usually this is done because a disc is protruding and pressing on the nerve structures. Removing the bone around the bulging or herniated disc takes the pressure off the cord and spinal nerves in that area.
When a laminectomy is done at multiple levels without a fusion to stabilize the spine, the bones can collapse like in your situation. Instead of a nice curve in the neck (called lordosis), the bones line up either too straight or curved in the opposite direction (called kyphosis).
The risk of pressure on the spinal cord or spinal nerve roots and possible paralysis is too great to just leave the patient with this postlaminectomy kyphosis. That's why a fusion has been recommended. The problem of postlaminectomy cervical kyphosis is a complex one and treatment can be challenging.
Most patients with this type of problem would have a circumferential fusion -- one that goes all the way around front to back. A circumferential approach requires two procedures: one from the front of the spine and one from behind (posterior). Efforts are being made to find alternate ways to treat this problem.
One surgeon in South Korea has used a hybrid technique. Instead of a fusion all the way around the spinal segments, the affected bone(s) and disc(s) are removed and fusion is done from the front of the spine (anterior approach). This approach eliminates the complications of spinal cord damage while still stabilizing the neck.
The surgeon uses screws or pins to help distract the bones and realign them. A metal plate and bone graft material are used to hold everything together in a more normal alignment. The long-term results are good with elimination of symptoms and maintenance of the improved cervical curve.
Yung Park, MD, et al. The Long-Term Results of Anterior Surgical Reconstruction in Patients with Postlaminectomy Cervical Kyphosis. In The Spine Journal. May 2010. Vol. 10. No. 5. Pp. 380-387.
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