Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), singl
CPT4 code
Name of the Procedure:
Percutaneous Laminotomy/Laminectomy (Interlaminar Approach) for Decompression of Neural Elements, with or without Ligamentous Resection, Discectomy, Facetectomy, and/or Foraminotomy, any method, under Indirect Image Guidance (e.g., Fluoroscopic, CT).
Summary
In simpler terms, this is a minimally invasive surgery to relieve pressure on spinal nerves. It involves removing small parts of bone or tissue to create more space for the nerves, often using imaging technology like CT scans or X-rays for precise guidance.
Purpose
This procedure primarily addresses conditions that compress spinal nerves, such as herniated discs or spinal stenosis, aiming to alleviate pain, numbness, or weakness associated with these conditions.
Indications
Typical indicators for this procedure include chronic back or leg pain, numbness, or weakness that doesn’t improve with conservative treatments. Ideal candidates are those experiencing significant nerve compression confirmed through imaging studies and clinical evaluation.
Preparation
Patients may need to fast for several hours before the procedure, adjust or stop certain medications (e.g., blood thinners), and undergo pre-procedure imaging studies like MRI or CT scans to pinpoint the affected area.
Procedure Description
- Anesthesia: The patient is typically given local anesthesia and sedation.
- Incision: A small incision is made near the affected area of the spine.
- Imaging Guidance: Fluoroscopic or CT imaging helps guide the surgeon to the precise location.
- Removal: The surgeon uses specialized instruments to remove small amounts of bone, ligament, or disc material compressing the nerve(s).
- Closure: The incision is closed with sutures or staples.
Duration
The procedure usually takes 1 to 2 hours, depending on complexity.
Setting
This procedure is commonly performed in a hospital operating room or an outpatient surgical center.
Personnel
The medical team typically includes an orthopedic or neurosurgeon, anesthesiologist, surgical nurses, and radiologic technologists.
Risks and Complications
- Common: Infection, bleeding, nerve damage, or dural tears.
- Rare: Adverse reactions to anesthesia, chronic pain, or recurrence of symptoms.
Benefits
- Relief from pain, numbness, or weakness.
- Minimally invasive with smaller incisions, potentially leading to quicker recovery times.
Recovery
Patients usually go home the same day or after a short hospital stay. Post-procedure instructions include limited physical activity, wound care, and avoiding strenuous tasks for several weeks. Follow-up appointments are essential to monitor healing and progress.
Alternatives
- Physical therapy
- Epidural steroid injections
- Open laminectomy or traditional surgery
- Each alternative has its own set of benefits and drawbacks, often discussed with the healthcare provider.
Patient Experience
During the procedure, the patient might feel slight pressure but should not experience pain due to anesthesia. Post-procedure, mild discomfort or soreness is possible, managed with prescribed pain medication and rest.