I had a bit of surgery to relieve pressure on my neck at the C56 level. The surgeon made a little door in the bone to swing it open and away from my spinal cord. I thought it worked great because my pain was completely gone. But now it's starting to come back. Does this happen very often and what happens next?
One of the most popular surgical procedures to decompress (take pressure off) the spinal cord is an open-door laminoplasty. It sounds like that's what you had done. A laminoplasty involves cutting through the lamina on one side and swinging the bone away from the spinal cord. It's much like swinging a door open, which is why it's called an open-door laminoplasty.
The surgeon places special laminoplasty plates on the opposite side to help hold the door open. It's a popular procedure because patients get pain relief without causing harm or injury to any of the soft tissues or spinal structures. Studies show that recovery from neurologic symptoms following an open-door procedure is as high as 72 per cent.
But in up to 10 per cent of the time, the symptoms may be only partially relieved or they may get worse. This can happen when the underlying problem (arthritis, degenerative changes) gets worse, causing more stenosis (narrowing of the spinal canal). This cause of symptom recurrence is referred to as disease progression. And in some cases symptoms come back or get worse because there just wasn't enough decompression to relieve the spinal cord compression.
In either case, a revision surgery may be needed. The type of revision procedures done varies. The surgeon may remove the lamina from around the spinal cord. This procedure is called a laminectomy. Sometimes enough bone is removed during the laminectomy that a spinal fusion is required. Motion in the neck is limited by fusing spinal segments together, but the added stability provides symptom relief.
You'll want to discuss the potential cause of your worsening symptoms with your surgeon. He or she will be able to advise you as to the best course of action. Don't wait to get a follow-up appointment. It may be possible to correct the problem quickly and easily early on before other problems develop.
Gabriel Liu, MD, et al. Revision Surgery Following Cervical Laminoplasty. Etiology and Treatment Strategies. In Spine. December 1, 2009. Vol. 34. No. 25. Pp. 2760-2768.
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