63190 Laminectomy with rhizotomy; more than 2 segments

Name of the Procedure:

Laminectomy with Rhizotomy; also known as Decompressive Laminectomy with Rhizotomy for Multiple Segments

Summary

A laminectomy with rhizotomy is a surgical procedure aimed at relieving pain caused by nerve compression in the spine. It involves removing part of the vertebrae (laminectomy) and severing specific nerve roots (rhizotomy) to alleviate chronic pain.

Purpose

This procedure addresses spinal stenosis, herniated discs, or other conditions that compress spinal nerves, causing severe pain, numbness, or weakness. The goal is to decompress the nerves, reduce pain, and improve spinal function and mobility.

Indications

• Chronic back or leg pain not relieved by conservative treatments.
• Neurological deficits such as muscle weakness or numbness.
• Herniated discs compressing nerve roots.
• Spinal stenosis affecting more than two segments.
• Failed previous spinal surgery.

Preparation

• Pre-operative fasting for 8 hours.
• Stopping certain medications like blood thinners.
• Diagnostic imaging such as MRI or CT scan.
• Routine blood tests and physical examination.

Procedure Description

1. The patient is positioned face-down on the operating table.
2. General anesthesia is administered.
3. An incision is made over the affected spine segments.
4. Muscles and soft tissues are moved aside to expose the vertebrae.
5. The lamina (part of the vertebra) is removed to relieve pressure on the spinal cord and nerves.
6. Rhizotomy is performed by severing or cutting the nerve roots causing pain.
7. The incision is closed with stitches or staples.
8. The area is cleaned and bandaged.

Duration

The procedure typically takes 2 to 4 hours, but this can vary depending on the number of segments involved.

Setting

This surgery is performed in a hospital or a specialized surgical center.

Personnel

• Orthopedic or neurosurgeon.
• Anesthesiologist.
• Surgical nurses and assistants.
• Operating room technicians.

Risks and Complications

• Infection.
• Bleeding.
• Nerve damage resulting in weakness or numbness.
• Spinal fluid leakage.
• Adverse reactions to anesthesia.
• Blood clots.

Benefits

• Significant pain relief.
• Improved mobility and function.
• Reduced need for pain medications.
• Enhanced quality of life.

Recovery

• Initial hospital stay of 1-3 days.
• Pain management with prescribed medications.
• Physical therapy to aid recovery and mobility.
• Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments for wound checks and progress assessment.

Alternatives

• Physical therapy and exercises.
• Pain management with medications or injections.
• Less invasive procedures like epidural steroid injections or spinal decompression.
• Pros: Less invasive, shorter recovery.
• Cons: May not provide long-term relief for severe conditions.

Patient Experience

During the procedure, the patient will be under general anesthesia and unaware of the surgery. Post-procedure, they may experience pain at the incision site, which is managed with medication. Initial discomfort and mobility restrictions are expected, gradually improving with rehabilitation and physical therapy.