63017 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; lumbar

Name of the Procedure:

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), more than 2 vertebral segments; lumbar.

Summary

A laminectomy is a surgical procedure where a portion of the vertebral bone called the lamina is removed to relieve pressure on the spinal cord or nerves. This version of the procedure focuses on decompressing the spinal cord or cauda equina in the lower back (lumbar) region, without removing any part of the facet joints, opening the foramina, or removing any discs.

Purpose

The primary purpose of a lumbar laminectomy is to alleviate pain and other symptoms caused by spinal stenosis, where the spinal canal narrows and compresses the spinal cord or surrounding nerves. The expected outcomes include reduced pain, increased mobility, and improved overall function.

Indications

• Chronic back or leg pain due to spinal stenosis
• Numbness, tingling, or weakness in the legs
• Difficulty walking or standing for extended periods
• Failed response to conservative treatments such as physical therapy or medications

Preparation

• Preoperative consultation with the surgical team
• Fasting for at least 8 hours before the procedure
• Discontinuation or adjustment of certain medications (e.g., blood thinners)
• Preoperative imaging tests such as MRI or CT scans to precisely identify the affected area

Procedure Description

1. The patient is positioned face-down on the operating table.
2. General anesthesia is administered to ensure the patient is asleep and pain-free.
3. A small incision is made in the middle of the lower back.
4. Muscles and tissues are gently retracted to expose the vertebrae.
5. The lamina is carefully removed to create more space within the spinal canal.
6. Any tissue compressing the spinal cord or nerves is identified and alleviated.
7. The incision is closed with sutures or staples, and a sterile dressing is applied.

Standard surgical tools and possibly microscopic or endoscopic equipment are used throughout the procedure.

Duration

Usually takes 2-3 hours, depending on the complexity and the number of vertebral segments involved.

Setting

Typically performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Possibly a surgical technologist

Risks and Complications

• Infection
• Bleeding
• Nerve injury leading to weakness or numbness
• Spinal fluid leak
• Blood clots
• Damage to surrounding tissues

Benefits

• Relief from chronic pain
• Improved mobility and function
• Enhanced quality of life

Benefits are often realized within a few weeks to a couple of months post-surgery.

Recovery

• Initial hospital stay for 1-3 days
• Restricted activities, avoiding heavy lifting or twisting movements for several weeks
• Physical therapy to aid recovery
• Follow-up appointments to monitor healing

Complete recovery may take several months, with gradual return to normal activities.

Alternatives

• Physical therapy and exercise regimens
• Pain management through medications or injections
• Minimally invasive procedures like spinal injections
• Other surgical options like discectomy or spinal fusion

Each alternative has its own benefits and risks which should be discussed with the healthcare provider.

Patient Experience

During the procedure, the patient will be unconscious due to general anesthesia. Postoperatively, some pain or discomfort is expected, which will be managed with medications. In the days and weeks following the surgery, patients may experience fatigue and require assistance with daily activities but should notice significant improvement in symptoms as they recover.