63012 Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure)

Name of the Procedure:

Laminectomy with Removal of Abnormal Facets and/or Pars Inter-Articularis with Decompression of Cauda Equina and Nerve Roots for Spondylolisthesis (Gill Type Procedure)

Summary

This surgical procedure involves removing portions of the vertebrae in the lower spine (lumbar region) to relieve pressure on the spinal cord and nerve roots. It is specifically designed to correct problems related to spondylolisthesis, a condition where one of the vertebrae slips out of place onto the bone below it.

Purpose

This procedure primarily addresses lumbar spondylolisthesis. The goals include alleviating pain, restoring normal nerve function, and improving the stability of the spine. It helps to decompress the cauda equina and nerve roots, which reduces pressure and irritation.

Indications

• Persistent lower back pain and leg pain
• Numbness or weakness in the legs
• Reduced spinal mobility
• Diagnosis of lumbar spondylolisthesis, especially when conservative treatments have failed

Preparation

• Patients will typically need to fast overnight before the surgery.
• Certain medications, especially blood thinners, may need to be adjusted or stopped as directed by the healthcare provider.
• Preoperative imaging tests, such as MRI or CT scans, might be necessary to assess the spine.

Procedure Description

1. Anesthesia is administered, usually general anesthesia.
2. A small incision is made over the affected area of the spine.
3. The surgeon carefully removes the lamina portion of the vertebrae and potentially abnormal facets or pars inter-articularis.
4. The cauda equina and nerve roots are decompressed by removing any structures that are causing impingement.
5. The stability of the spine may be reinforced with screws or rods if needed.
6. The incision is closed using sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 2 to 5 hours, depending on the complexity and extent of the spinal issues being addressed.

Setting

Laminectomy procedures are generally performed in a hospital setting, often in a specialized operating room for spinal surgeries.

Personnel

• Orthopedic surgeon or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Scrub technicians

Risks and Complications

• Infection
• Blood clots
• Nerve injury leading to numbness or weakness
• Persistent pain
• Spinal instability
• Cerebrospinal fluid leakage

Benefits

• Relief from chronic pain
• Improved mobility and function
• Reduced nerve symptoms like tingling or numbness
• Enhanced quality of life

Recovery

• Patients might stay in the hospital for a few days post-surgery.
• Physical therapy often starts soon after surgery to aid recovery.
• Patients should avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments are essential to monitor healing and spinal stability.

Alternatives

• Conservative treatments such as physical therapy, exercise, and pain management
• Epidural steroid injections
• Spinal fusion surgery if laminectomy is not suitable

Patient Experience

Patients should expect some pain and discomfort post-surgery, which will be managed with medications. Gradual recovery of strength and mobility can be expected, with substantial improvement often noticed within a few weeks to months.