Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical
CPT4 code
Name of the Procedure:
Laminectomy, Facetectomy, and Foraminotomy (Unilateral or Bilateral with Decompression of Spinal Cord, Cauda Equina, and/or Nerve Root[s], [e.g., Spinal or Lateral Recess Stenosis]), Single Vertebral Segment; Cervical
Summary
In layman's terms, this procedure involves surgically removing parts of the spine to relieve pressure on the spinal cord or nerve roots. It is typically performed to address issues in the cervical (neck) region of the spine.
Purpose
The procedure aims to alleviate pressure caused by spinal stenosis, herniated discs, or other spinal issues that compress the nerves or spinal cord. The goals are to reduce pain, improve mobility, and prevent further neurological damage.
Indications
- Chronic neck pain
- Arm pain or numbness
- Muscle weakness
- Spinal stenosis
- Herniated discs
- Degenerative spinal conditions
- Radiculopathy (nerve pain radiating from the spine to the limbs)
Preparation
- Patients may be required to fast for a specific period before the surgery.
- Medications may need to be adjusted under medical supervision.
- Preoperative imaging tests like MRI or CT scans are usually required.
- Blood tests and a thorough medical evaluation will be conducted to ensure the patient's fitness for surgery.
Procedure Description
- An incision is made in the back of the neck to access the spine.
- The surgeon removes parts of the vertebrae (lamina) to create more space in the spinal canal.
- Adjacent facet joints may be trimmed or removed (facetectomy).
- If necessary, part of the intervertebral foramen (foraminotomy) is removed to relieve pressure on the nerve roots.
- The surgical area is then closed with sutures or staples.
- The patient is monitored in recovery for any immediate complications.
Specialized surgical tools and imaging technology, such as microscopes or endoscopes, may be used for precision. General anesthesia is typically administered.
Duration
The procedure generally takes 2 to 4 hours, depending on the complexity and the patient's specific condition.
Setting
This surgery is performed in a hospital's operating room, where postoperative monitoring is readily available.
Personnel
- Neurosurgeon or orthopedic spine surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Nerve damage
- Spinal fluid leak
- Failure to relieve symptoms
- Anasthetic risks
- Rarely, paralysis
Benefits
- Relief from chronic pain
- Improved mobility and function
- Reduced risk of permanent nerve damage
- Enhanced quality of life
Benefits are usually noticeable a few weeks to a few months after surgery, depending on individual recovery rates.
Recovery
- Hospital stay of 1-3 days
- Pain management with medications
- Physical therapy may be recommended
- Avoid heavy lifting and strenuous activities for several weeks
- Follow-up appointments to monitor progress
Alternatives
- Physical therapy
- Medications (pain relievers, anti-inflammatory drugs)
- Epidural steroid injections
- Minimally invasive spine surgery
- Lifestyle changes like weight loss and exercise
Alternatives might offer relief with less risk but could be less effective if the spinal compression is severe.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel pain. Postoperatively, there may be discomfort and pain at the incision site, managed with medication. Movement may be restricted initially, and physical therapy will be essential for recovery. Pain and symptoms usually improve significantly over several weeks.