Cervical Spinal Stenosis Surgery (Posterior Cervical Laminectomy and Lateral Mass Fixation)

The method we most often use for cervical stenosis surgery is posterior cervical laminectomy. Under general anaesthesia, an incision at the back of the neck allows removal of the bony structures (laminae) compressing the nerves, widening the spinal canal. If vertebral slippage or instability is present, lateral mass screw fixation and fusion are performed in the same session. Patients get up 4–6 hours after surgery, and hospital stay is 1–2 days.

What Is Spinal Stenosis Surgery, and How Is It Performed?

Surgery becomes necessary when cervical spinal stenosis cannot be controlled non-surgically or neurological findings such as progressive weakness develop. It is the primary treatment, particularly for moderate and severe spinal cord involvement (myelopathy). Depending on the level of narrowing and cervical alignment, anterior operations or laminoplasty are also options.

Surgical Procedure and Anatomical Approach

Entry Point and Muscle-Preserving Approach

The operation is performed under general anaesthesia in a fully equipped operating theatre. A skin incision suitable for microsurgery is made at the back of the neck over the narrowed level. The neck muscles are carefully retracted to both sides without damaging spinal anatomy.

Widening the Canal (Laminectomy)

The laminae, the bony roof covering the spinal cord from behind and compressing nerves because of narrowing, are removed under microscopic vision. This is called laminectomy. Removing the bony roof widens the canal and relieves pressure on nerve tissues.

Spinal Instability and Lateral Mass Screw Fixation

Some patients already have vertebral slippage (instability) before surgery. Alternatively, the extensive bone removal needed to relieve narrowing may be expected to disrupt spinal biomechanics and cause future slippage. In these situations, the following stabilisation is performed during the same operation to preserve the spine’s original structure:

• Lateral Mass Screw Fixation: Appropriately sized titanium screws are inserted at suitable angles into the lateral masses, the posterolateral parts of the vertebrae.
• Fixation and Fusion: Special rods connect the screws, fixing the vertebrae and allowing secure bony union over time. This protects the patient from postoperative vertebral slippage.

What Is the Success Rate?

Surgery aims to stop disease progression and improve function by relieving spinal cord compression. A study of 278 patients combining anterior and posterior operations found significant improvements in function, disability and quality-of-life scores 1 year after surgery. These occurred in all mild, moderate and severe myelopathy groups, regardless of preoperative symptom severity [1]. An international study of 479 patients produced the same result [2]. For patients with moderate to severe myelopathy involving reduced hand dexterity, unsteady walking and arm weakness, surgery is the treatment recommended by the international guideline [3].

What Are the Risks?

Operations to widen the cervical spinal canal are advanced procedures requiring considerable experience. Temporary shoulder and arm weakness (C5 palsy) from stretching of the C5 nerve root as the cord moves backwards after decompression is a well-known complication. It usually improves over months with physiotherapy. Neuromonitoring, which tracks nerve conduction in real time during surgery, is used to minimise spinal cord and nerve root injury risks. Screw-placement problems, dural tears, neck pain, wound infection and nonunion in fusion patients are other complications occurring at low rates. The 278-patient study reported an overall complication rate of 18.7%, consistent with similar series [1].

🩺 Physician’s Insight & Clinical Experience

“Stenosis surgery is one of the operations in which a neurosurgeon must respect spinal biomechanics most carefully. Entering from the back of the neck and relieving the compressed cord is the first stage. The second is answering during surgery, ‘I have removed this bone, but will the spine slip later?’ and adding lateral mass screws if needed. Seeing our patient walk safely after fixation, head held high and feet firmly on the ground, makes all our fatigue disappear.”

Frequently Asked Questions

What Is Cervical Stenosis Surgery, and How Is It Performed?

Through an incision at the back of the neck, the bony structures (laminae) compressing the nerves are removed under microscopic vision. If necessary, lateral mass screws stabilise the spine during the same operation.

What Is Its Success Rate?

Significant improvement in function and quality of life at 1 year has been shown in all mild, moderate and severe myelopathy groups. Two multicentre studies involving 278 and 479 patients found the same result [1, 2].

Does It Have Risks or Side Effects?

Yes, although serious complications are rare. The best-known is temporary C5 palsy (shoulder and arm weakness), which usually improves within months. The overall complication rate has been reported as 18.7% [1].

Is There a Risk of Paralysis?

Yes, but it is low: a large international study found a neurological complication rate of 3.1% [2]. We operate under a microscope with neuromonitoring that tracks nerve conduction in real time.

When Can I Get Up?

Our patients can stand and walk with the healthcare team’s assistance approximately 4–6 hours after surgery, once the anaesthetic has worn off. Hospital stay is 1–2 days.

Will My Stenosis Symptoms Improve After Surgery?

Yes, severe arm pain and cramps usually decrease markedly the next day. However, numbness and tingling in nerves affected by prolonged compression may take several weeks to resolve completely, depending on nerve-fibre recovery.

When Can I Return to Work?

Patients with desk jobs or non-physical occupations can return after 10–15 days. For physically demanding work or heavy lifting, this may extend to 4–6 weeks.

Which Specialist Performs Cervical Stenosis Surgery in Istanbul?

One of the physicians performing cervical stenosis surgery in Istanbul is M. Levent Deniz, MD, a specialist in brain, nerve and spine surgery.

How Much Does Cervical Stenosis Surgery Cost?

As treatment costs vary according to the patient and hospital conditions, a definite fee can only be determined after examination and review of imaging.

References

1. Fehlings MG, Wilson JR, Kopjar B, et al. Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study. J Bone Joint Surg Am. 2013;95(18):1651-1658. PMID: 24048552.
2. Fehlings MG, Ibrahim A, Tetreault L, et al. A global perspective on the outcomes of surgical decompression in patients with cervical spondylotic myelopathy: results from the prospective multicenter AOSpine international study on 479 patients. Spine (Phila Pa 1976). 2015;40(17):1322-1328. PMID: 26020847.
3. Fehlings MG, Tetreault LA, Riew KD, et al. A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy. Global Spine J. 2017;7(3 Suppl):70S-83S. PMID: 29164035.

• 👨‍⚕️ Author and medical reviewer of this content: M. Levent Deniz, MD – Brain, Nerve and Spine Surgeon
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.