63050 Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments

Name of the Procedure:

Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments

Summary

Laminoplasty is a surgical procedure that involves creating more space in the spinal canal by reshaping or repositioning one or more vertebrae in the cervical (neck) region. This helps to relieve pressure on the spinal cord and nerves.

Purpose

Medical Condition:

• Cervical spinal stenosis
• Myelopathy (compression of the spinal cord)

Goals/Outcomes:

• Relieve pressure on the spinal cord
• Improve or stabilize neurological function
• Alleviate pain, numbness, and weakness in the neck, shoulders, and arms

Indications

• Chronic neck pain with or without radiating pain to the arms
• Numbness, weakness, or coordination problems in the upper limbs
• Diagnosed spinal cord compression via imaging studies (MRI, CT scan)
• Failure of conservative treatments like physical therapy or medications

Preparation

• Pre-Procedure Instructions: Patients may need to fast for 8 hours before surgery. They must stop taking certain medications as advised by their doctor.
• Diagnostic Tests: MRI or CT scans to assess the extent of spinal cord compression. Blood tests and a general health evaluation.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A small incision is made in the back of the neck.
3. Exposure: Muscles are moved aside to expose the vertebrae.
4. Laminar Resection: The surgeon cuts and lifts the lamina (the back part of the vertebra), creating more space within the spinal canal.
5. Decompression: Any additional sources of compression, such as bone spurs, may also be removed.
6. Stabilization: The lamina is repositioned and may be secured with small metal plates or sutures to ensure it stays in place.
7. Closure: The incision is closed with stitches.

Duration

The procedure typically takes 2 to 4 hours, depending on the number of vertebral segments involved.

Setting

Laminoplasty is usually performed in a hospital operating room.

Personnel

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

Risks and Complications

• Common Risks: Infection, bleeding, pain at the surgical site
• Rare Risks: Nerve damage, spinal fluid leak, instability in the cervical spine, worsening of symptoms
• Management: Infection control, pain management, and in rare cases, additional surgeries.

Benefits

• Reduced pressure on the spinal cord
• Improved or stabilized neurological function
• Relief from pain and other symptoms
• Enhanced quality of life
• Benefits are usually noticeable within a few weeks to a couple of months post-surgery

Recovery

• Immediate Care: Pain management, wound care
• Follow-up: Physical therapy sessions may begin within a few weeks.
• Restrictions: Limited neck movements, no heavy lifting or strenuous activities for at least 6 weeks
• Recovery Time: Full recovery can take 2 to 3 months, depending on the individual and the extent of the surgery.

Alternatives

• Conservative Treatments: Physical therapy, medication, and lifestyle modifications
• Other Surgical Options: Anterior cervical discectomy and fusion (ACDF), cervical laminectomy
• Pros/Cons: Non-surgical options may not provide permanent relief and surgical alternatives have different risk profiles and recovery times.

Patient Experience

• During: The patient is under general anesthesia and will not feel anything.
• Post-Procedure: Soreness and stiffness in the neck, managed with pain medication and gradual physical activity. Patients may use a neck collar for support in the initial weeks. Regular follow-ups for monitoring recovery are necessary.