Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar (List separately in addition to code for primar
CPT4 code
Name of the Procedure:
Laminotomy (Hemilaminectomy) with Decompression of Nerve Root(s), Including Partial Facetectomy, Foraminotomy, and/or Excision of Herniated Intervertebral Disc; Each Additional Interspace, Cervical or Lumbar
Summary
A laminotomy, also known as a hemilaminectomy, is a surgical procedure performed to relieve pressure on the nerve roots in the spine. This may involve the removal of part of the vertebral bone (lamina) and other structures that are compressing the nerves.
Purpose
This procedure addresses spinal nerve root compression, often due to herniated discs, bone spurs, or spinal stenosis. The primary goal is to alleviate pain, numbness, and weakness in the arms or legs, thereby improving the patient's quality of life and functionality.
Indications
- Persistent and severe pain in the neck or lower back that radiates to the arms or legs.
- Numbness, tingling, or weakness in extremities due to compressed nerve roots.
- Diagnosed herniated intervertebral disc or spinal stenosis not responding to conservative treatments.
- Failed relief from other non-surgical interventions.
Preparation
- Patients may be required to fast for 8-12 hours before the procedure.
- Medications, especially blood thinners, may need to be adjusted.
- Preoperative tests can include MRI, CT scans, or X-rays to precisely identify the affected area.
- Pre-surgical clearance from the primary care provider and any necessary specialists.
Procedure Description
- Anesthesia is administered; general anesthesia is typically used.
- A small incision is made over the affected vertebra.
- Muscles are retracted to expose the vertebra and lamina.
- A portion of the lamina is removed to provide access to the compressed nerve root.
- Partial facetectomy and foraminotomy are performed as needed to ensure decompression.
- Any herniated disc fragments are excised.
- Muscles and tissues are repositioned, and the incision is closed with sutures or staples.
- A sterile dressing is applied over the incision site.
Duration
The procedure typically takes between 1 to 3 hours, depending on the complexity and number of interspaces treated.
Setting
This surgery is usually performed in a hospital or specialized surgical center.
Personnel
- Orthopedic or neurosurgeon
- Anesthesiologist
- Surgical nurses
- Scrub technician
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma
- Damage to nerve roots or spinal cord
- Spinal instability
- Recurrence of symptoms
- Chronic pain at the incision site
Benefits
- Relief from chronic pain
- Improved mobility and function
- Reduction in neurological symptoms like numbness and weakness
- Enhanced quality of life
Recovery
- Patients are usually observed overnight and may go home the next day.
- Postoperative care includes pain management, wound care, and physical therapy.
- Most patients can return to normal activities within 4-6 weeks, although heavy lifting and strenuous activities should be avoided for several months.
- Follow-up appointments to monitor healing and progress.
Alternatives
- Physical therapy and exercise programs
- Pain management strategies such as medications or injections
- Minimally invasive procedures like epidural steroid injections
- Spinal fusion surgery in severe or widespread cases
Patient Experience
During the procedure, patients will be under general anesthesia and will not feel anything. Postoperatively, there might be some discomfort at the incision site, manageable with prescribed pain medications. Gradual improvement in symptoms is typically observed over several weeks, with careful adherence to follow-up care and physical therapy recommendations.