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Laminectomy and Fusion

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The choice of surgical approach in the management of individuals with SCI is dependent on a myriad of factors. These include individual age and comorbid status, the location of injury, the severity of neurologic injury, the extent of cord compression and any mechanical instability. In general, there is a need to decompress the spine in cases of canal compromise and to stabilize the column. At any level of the spine, one may choose to perform a laminectomy for decompression; this is most commonly accompanied by spinal fusion. In the cervical spine, posterior decompression may be accompanied by the placement of lateral mass screws or with the addition of an anterior cervical discectomy and fusion. Thoracolumbar fractures that cause incomplete injury, ongoing cord compression and instability are most frequently treated by laminectomy and fusion. If there is no need for decompression, one may choose a percutaneous instrumentation technique.

Table 12 Laminectomy and Fusion

Discussion

Cervical or thoracolumbar SCI is often accompanied by canal compromise or by mechanical instability. In individuals with incomplete injury it is imperative to remove any cord compression and to prevent abnormal movements of the bony elements of the column which may threaten worsening injury. Hence, there is a clear justification for proposing decompressive laminectomies with or without instrumented fusion. In the cervical spine, posterior decompression may be augmented by posterior or anterior fusion while thoracolumbar fractures are often stabilized posteriorly.

An analysis of the National Individual Sample by Boakye et al. (2008) found a low rate of mortality in individuals undergoing these individuals in the US. Moreover, the risk of in-hospital mortality was significantly affected by individual age and existing co-morbidities. This study also found that a single post-operative complication doubled the length of stay and increased risk of mortality 5-fold.

  • It is impossible to compare laminectomy and fusion with conservative management in individuals who have ongoing cord compression or column instability. The clinical utility of decompressive laminectomies is obvious; however, in appropriately selected individuals one may elect to perform a percutaneous technique.