63278 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral

Name of the Procedure:

Laminectomy for Biopsy/Excision of Intraspinal Neoplasm; Extradural, Sacral

Summary

A laminectomy for biopsy or excision of an intraspinal neoplasm (tumor) involves removing part of the sacral vertebra to access and remove or biopsy a tumor located outside the spinal dura mater within the sacral region.

Purpose

This procedure addresses tumors located outside the spinal dura mater (extradural) in the sacral area. It aims to remove the neoplasm for therapeutic reasons or to obtain a tissue sample for diagnosis. The expected outcomes include alleviating symptoms, halting the progression of the tumor, and obtaining an accurate diagnosis.

Indications

• Persistent lower back pain not relieved by conservative treatments
• Neurological deficits such as numbness, weakness, or bladder/bowel dysfunction
• Radiological findings indicating an extradural sacral tumor
• Biopsy needed for diagnosis and treatment planning

Preparation

• Pre-procedure imaging tests such as MRI or CT scans
• Blood tests and a complete medical evaluation
• Fasting for at least 8 hours before the procedure
• Adjustments to medications as advised by the physician, especially blood thinners
• Discussing anesthesia options and any allergies with the anesthesiologist

Procedure Description

1. The patient is positioned prone (lying face down) on the operating table.
2. General anesthesia is administered.
3. A small incision is made over the sacral region.
4. Muscles and tissues are carefully moved aside to expose the lamina (part of the vertebrae).
5. The laminae are partially removed (laminectomy) to access the extradural space.
6. The tumor is either biopsied (a sample is taken) or excised (totally removed).
7. The surgical site is closed using sutures or staples.
8. The incision is dressed and bandaged.

Duration

The procedure typically takes around 2 to 4 hours, depending on the complexity and size of the neoplasm.

Setting

This procedure is performed in a hospital operating room, typically with an overnight stay for observation.

Personnel

• Neurosurgeon or orthopedic spine surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the site of surgery
• Bleeding or hematoma formation
• Damage to nerves or spinal cord leading to neurological deficits
• Cerebrospinal fluid leak
• Persistent pain or discomfort
• Anesthesia-related complications

Benefits

• Relief of pain and neurological symptoms
• Prevention of further neurological deterioration
• Accurate diagnosis of the neoplasm
• Potential for complete removal of the tumor

Recovery

• Hospital stay for 1-2 days post-procedure
• Pain management with medications
• Gradual return to normal activities over 4 to 6 weeks
• Physical therapy may be recommended
• Follow-up appointments for wound check and to discuss biopsy results

Alternatives

• Non-surgical management with medications and physical therapy
• Radiation therapy or chemotherapy for certain types of tumors
• Minimally invasive biopsy techniques
• Each alternative has its own risks and benefits depending on the specific medical situation

Patient Experience

Patients may experience pain and discomfort immediately after the procedure, which is managed with pain medications. They might feel groggy and tired due to anesthesia. During recovery, patients may need assistance with daily activities and should follow all guidelines provided by their healthcare team to ensure proper healing.