63047 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; lumbar

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; Lumbar

Summary

A laminectomy, facetectomy, and foraminotomy are surgical procedures performed on the spine to relieve pressure on the spinal cord, cauda equina, and nerve roots by removing parts of the vertebral bone and other structures.

Purpose

These procedures address spinal stenosis and other conditions causing nerve compression in the lumbar (lower back) region. The goal is to alleviate pain and other symptoms like numbness, tingling, or weakness in the legs.

Indications

• Severe lower back pain that does not respond to conservative treatments
• Symptoms indicating nerve compression such as leg pain, numbness, or weakness
• Diagnosed lumbar spinal stenosis
• Conditions like herniated discs causing nerve root compression
• Degenerative spinal diseases

Preparation

• Patients may need to fast for several hours before the surgery.
• Adjustments or temporary cessation of certain medications, particularly blood thinners.
• Preoperative imaging studies like MRI or CT scans.
• Routine blood tests and a pre-anesthetic check-up.

Procedure Description

1. Under general anesthesia, an incision is made in the midline of the lower back.
2. Muscles are gently moved aside to access the vertebral column.
3. A laminectomy involves removing part of the vertebral bone (lamina) to relieve pressure.
4. A facetectomy entails the removal of part of the facet joints.
5. Foraminotomy is performed to enlarge the foramen (the passageway where the nerve roots exit the spine).
6. The surgeon ensures the decompression of the spinal cord, cauda equina, and/or nerve roots.
7. The incision is closed, and sterile dressing is applied.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity.

Setting

The surgery is usually performed in a hospital or specialized surgical center.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses and technologists

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Dural tear (tear in the covering of the spinal cord)
• Postoperative pain
• Recurrence of symptoms or need for additional surgery

Benefits

• Relief from chronic lower back and leg pain.
• Improved mobility and quality of life.
• Reduced or eliminated need for long-term pain medication.

Recovery

• Short hospital stay, typically 1 to 2 days.
• Gradual increase in activity over several weeks.
• Physical therapy may be recommended.
• Avoid heavy lifting or strenuous activities for several weeks.
• Follow-up appointments to monitor progress and ensure proper healing.

Alternatives

• Physical therapy and exercise
• Pain management including medications and injections
• Minimally invasive spinal surgery
• Spinal fusion
• Each alternative has its own pros and cons in terms of recovery time, effectiveness, and potential risks.

Patient Experience

During the procedure, the patient will be under general anesthesia and won't feel anything. Postoperatively, there might be pain at the incision site, managed with pain medications. Some patients may experience temporary nerve pain, which typically resolves as the body heals.