cervical laminectomy adverse outcomes

This operation involves removing the bone from the back part of the neck verterbrae.  It is usually done for severe compression of the spinal cord due to growth of arthritic tissue and/or disc material.  It is done to prevent PROGRESSION of neurological symptoms rather than with the expectation of improving lost neurological function.  It is NOT done with the hope of easing any neck discomfort although sometimes this does occur. 

 The following list covers most of the common and/or serious risks of cervical laminectomy.  However, you need to remember that the vast majority of patients have a good or excellent outcome from this operation and you need to keep in perspective the small chance of any of these events below occurring against the likely benefits of this operation.

INFECTION: Infections can either be close to the skin surface (superficial) or deep in the wound (deep).  The risk of a superficial wound infection is approximately 5 in 100 (5%).  The risk of a deep infection is less than1 in 100 (1%).  There is a less than 1 in 1000 (0.1%) risk of an infection of the sac containing the nerves (dura) or in the fatty space around the sac (epidural space) or of the disc (disciitis).  Extremely rarely the build up of pus may cause nerve damage and require further surgery to drain the pus.

 NERVE DAMAGE:  The risk of direct surgical damage of the nerves or spinal cord is less than 1 in 1000 (0.01%).  Nerve damage can cause only slight numbness or weakness to total loss of function below the level injured. Permanent loss of nerve function is very unlikely.

 DURAL TEARS:  The sac (dura) containing the spinal cord is usually very strong.  However it can be torn during surgery.  Often the tear can be sutured or patched but you may be required to spend some days after the operation flat in bed.  Very rarely with persisting leakage of the fluid in the sac (CSF) a further operation may be required to stop this. There have been isolated reports of cerebral (brain) haemorrhage occurring after dural tears.

 ARACHNOIDITIS/EPIDURAL SCAR: Scarring occurs around the nerves and the sac (epidural scar) and rarely may cause ongoing brachialgia in a few patients (less than 1 in 100 (1%)).  The scarring can be caused by both the associated inflammation from the arthritic material and from the surgery.  Less commonly (less than 1 in 100 (1%)) scarring occurs within the nerve itself (arachnoiditis).  Further surgery is unlikely to improve persisting symptoms from arachnoiditis and epidural scar.  Indeed if either of these problems occur treatment is limited.

 HAEMATOMA/EPIDURAL HAEMATOMA: Following any surgery excessive bleeding may occur.  The blood may then accumulate and form a clot (haematoma).  The risk of developing a superficial haematoma is less than 5 in 100 (5%).  The risk of a deep haematoma which surrounds the nerves (epidural haematoma) is less than 1 in 1000 (0.1%).  An epidural haematoma may press on the nerves and cause them to stop functioning properly and may necessitate further surgery to remove the blood clot.  A haematoma in the surgical wound may also very rarely press on the windpipe (trachea) in the first few hours after surgery and if severe may need urgent drainage.

 FAILURE OF FUSION: In around 2-3% of cases the bone graft (if used) fails to fuse across the bones.  This may not cause any problems but sometimes further surgery may be required to get the fusion to succeed.

 MISCELLANEOUS:  Sometimes this operation actually worsens neck pain.  Again this operation is not done to treat the neck pain – it is done to halt or at least slow down the progression of nerve damage and lost function from the pressure on the spinal cord

 DVT or PE: DVT (Deep Vein Thrombosis) refers to clots forming in the deep veins of the legs.  DVT's which cause symptoms occur in less than 5% (5 in 100) patients.  Clots may travel from the deep veins in the legs and lodge in the blood vessels in the lungs (PE or Pulmonary Embolus).  When this happens it may cause no symptoms at all but occasionally it can cause breathlessness and chest pain.  Extremely rarely ie, less than 1 in 1000 (0.01%) it can cause sudden death.

Please also note that it has been shown that smoking significantly increases the risks and complications of surgery and reduces the chance of a successful outcome.