Cervical Laminectomy and Fusion

  • Jacob JanuszewskiEmail author
  • Juan S. Uribe


Degenerative cervical myelopathy (DCM) is a result of a combination of compressive, dynamic, and biomolecular factors on the spinal cord. Compression arises from narrowing of the ventral/dorsal cervical canal, disc degeneration, spondylosis, and ossification of the posterior longitudinal ligament (PLL) and ligamentum flavum leading to direct pressure on the spinal cord. Dynamic forces arise from abnormal cervical spinal alignment or motion as in cases with degenerative spondylolisthesis, subluxation, or kyphotic deformity. Physiological narrowing of canal diameter with neck extension as well as strain/stretch forces placed on the spinal cord with physiological neck movements also contributes to dynamic pathophysiological stresses. Finally, ischemic injury from chronic compression, subsequent release of inflammatory factors, glutamate-mediated excitotoxicity, and eventually neuronal apoptosis contribute to CSM on a molecular and cellular level. The goal of surgery, in turn, is first to decompress the neural structures and reduce the effect of static and biomolecular factors and, second, to stabilize the dynamic factors if such need exists.


Degenerative cervical myelopathy DCM Cervical laminectomy Cervical spondylotic myelopathy CSM OPLL 


  1. 1.
    Wilson JR, Tetreault LA, Kim J, et al. State of the art in degenerative cervical myelopathy: an update on current clinical evidence. Neurosurgery. 2017;80:S33–s45.CrossRefGoogle Scholar
  2. 2.
    Steinmetz MP, Benzel EC. Benzel’s spine surgery: techniques, complication avoidance, and management. 4th ed. Philadelphia: Elsevier; 2016.Google Scholar
  3. 3.
    Divi SN, Mikhael MM. Use of allogenic mesenchymal cellular bone matrix in anterior and posterior cervical spinal fusion: a case series of 21 patients. Asian Spine J. 2017;11:454–62.CrossRefGoogle Scholar
  4. 4.
    Sawin PD, Traynelis VC, Menezes AH. A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions. J Neurosurg. 1998;88:255–65.CrossRefGoogle Scholar
  5. 5.
    Guzman JZ, Merrill RK, Kim JS, et al. Bone morphogenetic protein use in spine surgery in the United States: how have we responded to the warnings? Spine J Off J North Am Spine Soc. 2017;17(9):1247–54.CrossRefGoogle Scholar
  6. 6.
    Hamilton DK, Smith JS, Reames DL, et al. Safety, efficacy, and dosing of recombinant human bone morphogenetic protein-2 for posterior cervical and cervicothoracic instrumented fusion with a minimum 2-year follow-up. Neurosurgery. 2011;69:103–11; discussion 11.CrossRefGoogle Scholar
  7. 7.
    Hansraj KK. Stem cells in spine surgery. Surg Technol Int. 2016;XXIX:348–58.Google Scholar
  8. 8.
    McAllister BD, Rebholz BJ, Wang JC. Is posterior fusion necessary with laminectomy in the cervical spine? Surg Neurol Int. 2012;3:S225–31.CrossRefGoogle Scholar
  9. 9.
    Kim DK, Kim JY, Kim DY, et al. Risk factors of proximal junctional kyphosis after multilevel fusion surgery: more than 2 years follow-up data. J Korean Neurosurg Soc. 2017;60:174–80.CrossRefGoogle Scholar
  10. 10.
    Liu FY, Wang T, Yang SD, et al. Incidence and risk factors for proximal junctional kyphosis: a meta-analysis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2016;25:2376–83.CrossRefGoogle Scholar
  11. 11.
    Park SJ, Lee CS, Chung SS, et al. Different risk factors of proximal junctional kyphosis and proximal junctional failure following long instrumented fusion to the sacrum for adult spinal deformity: survivorship analysis of 160 patients. Neurosurgery. 2017;80:279–86.PubMedGoogle Scholar
  12. 12.
    Yagi M, King AB, Boachie-Adjei O. Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up. Spine. 2012;37:1479–89.CrossRefGoogle Scholar
  13. 13.
    Yagi M, Rahm M, Gaines R, et al. Characterization and surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity. Spine. 2014;39:E607–14.CrossRefGoogle Scholar
  14. 14.
    Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine. 1986;11:521–4.CrossRefGoogle Scholar
  15. 15.
    Hardacker JW, Shuford RF, Capicotto PN, et al. Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine. 1997;22:1472–80; discussion 80.CrossRefGoogle Scholar
  16. 16.
    Iyer S, Lenke LG, Nemani VM, et al. Variations in occipitocervical and cervicothoracic alignment parameters based on age: a prospective study of asymptomatic volunteers using full-body radiographs. Spine. 2016;41:1837–44.CrossRefGoogle Scholar
  17. 17.
    Janusz P, Tyrakowski M, Yu H, et al. Reliability of cervical lordosis measurement techniques on long-cassette radiographs. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2016;25:3596–601.CrossRefGoogle Scholar
  18. 18.
    Lee SH, Kim KT, Seo EM, et al. The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults. J Spinal Disord Tech. 2012;25:E41–7.CrossRefGoogle Scholar
  19. 19.
    Hey HWD, Teo AQA, Tan KA, et al. How the spine differs in standing and in sitting-important considerations for correction of spinal deformity. Spine J Off J North Am Spine Soc. 2017;17:799–806.CrossRefGoogle Scholar
  20. 20.
    Tan LA, Riew KD, Traynelis VC. Cervical spine deformity-part 1: biomechanics, radiographic parameters, and classification. Neurosurgery. 2017;81:197–203.CrossRefGoogle Scholar
  21. 21.
    Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2012;71:662–9; discussion 9.CrossRefGoogle Scholar
  22. 22.
    Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2015;76(Suppl 1):S14–21; discussion S.CrossRefGoogle Scholar
  23. 23.
    Li J, Qin S, Li Y, et al. Modic changes of the cervical spine: T1 slope and its impact on axial neck pain. J Pain Res. 2017;10:2041–5.CrossRefGoogle Scholar
  24. 24.
    Oe S, Togawa D, Nakai K, et al. The influence of age and sex on cervical spinal alignment among volunteers aged over 50. Spine. 2015;40:1487–94.CrossRefGoogle Scholar
  25. 25.
    Protopsaltis TS, Lafage R, Vira S, et al. Novel angular measures of cervical deformity account for upper cervical compensation and sagittal alignment. Clin Spine Surg. 2017;30:E959–e67.CrossRefGoogle Scholar
  26. 26.
    Cabraja M, Abbushi A, Koeppen D, et al. Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome. Neurosurg Focus. 2010;28:E15.CrossRefGoogle Scholar
  27. 27.
    Hann S, Chalouhi N, Madineni R, et al. An algorithmic strategy for selecting a surgical approach in cervical deformity correction. Neurosurg Focus. 2014;36:E5.CrossRefGoogle Scholar
  28. 28.
    Kim DH, Vaccaro AR, Dickman CA, Cho D, Lee S, Kim I. Surgical anatomy and techniques to the spine. 2nd ed. Philadelphia: Saunders Elsevier; 2006.Google Scholar
  29. 29.
    Singh K, Vaccaro AR. Minimally invasive spine surgery: advanced surgical techniques. 1st ed. New Delhi: Jaypee Brothers; 2016.CrossRefGoogle Scholar
  30. 30.
    Stemper BD, Marawar SV, Yoganandan N, et al. Quantitative anatomy of subaxial cervical lateral mass: an analysis of safe screw lengths for Roy-Camille and magerl techniques. Spine. 2008;33:893–7.CrossRefGoogle Scholar
  31. 31.
    Xu R, Haman SP, Ebraheim NA, et al. The anatomic relation of lateral mass screws to the spinal nerves. A comparison of the Magerl, Anderson, and An techniques. Spine. 1999;24:2057–61.CrossRefGoogle Scholar
  32. 32.
    Joseffer SS, Post N, Cooper PR, et al. Minimally invasive atlantoaxial fixation with a polyaxial screw-rod construct: technical case report. Neurosurgery. 2006;58:ONS-E375; discussion ONS-E.Google Scholar
  33. 33.
    Winder MJ, Thomas KC. Minimally invasive versus open approach for cervical laminoforaminotomy. Can J Neurol Sci. 2011;38:262–7.CrossRefGoogle Scholar
  34. 34.
    Yabuki S, Kikuchi S. Endoscopic partial laminectomy for cervical myelopathy. J Neurosurg Spine. 2005;2:170–4.CrossRefGoogle Scholar
  35. 35.
    Mikhael MM, Celestre PC, Wolf CF, et al. Minimally invasive cervical spine foraminotomy and lateral mass screw placement. Spine. 2012;37:E318–22.CrossRefGoogle Scholar
  36. 36.
    Wang MY, Levi AD. Minimally invasive lateral mass screw fixation in the cervical spine: initial clinical experience with long-term follow-up. Neurosurgery. 2006;58:907–12; discussion −12.CrossRefGoogle Scholar
  37. 37.
    Ahmad F, Sherman JD, Wang MY. Percutaneous trans-facet screws for supplemental posterior cervical fixation. World Neurosurg. 2012;78:716. e1–4.PubMedGoogle Scholar
  38. 38.
    Terterov S, Taghva A, Khalessi AA, et al. Symptomatic vertebral artery compression by the rod of a C1-C2 posterior fusion construct: case report and review of the literature. Spine. 2011;36:E678–81.CrossRefGoogle Scholar
  39. 39.
    Neo M, Fujibayashi S, Miyata M, et al. Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine. 2008;33:779–85.CrossRefGoogle Scholar
  40. 40.
    Albert TJ, Vacarro A. Postlaminectomy kyphosis. Spine. 1998;23:2738–45.CrossRefGoogle Scholar
  41. 41.
    Gu Y, Cao P, Gao R, et al. Incidence and risk factors of C5 palsy following posterior cervical decompression: a systematic review. PLoS One. 2014;9:e101933.CrossRefGoogle Scholar
  42. 42.
    Katsumi K, Yamazaki A, Watanabe K, et al. Analysis of C5 palsy after cervical open-door laminoplasty: relationship between C5 palsy and foraminal stenosis. J Spinal Disord Tech. 2013;26:177–82.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryBarrow Neurological InstitutePhoenixUSA
  2. 2.Department of NeurosurgeryThe B.A.C.K CenterMelbourneUSA

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