Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar
CPT4 code
Name of the Procedure:
Endoscopic decompression of the spinal cord and nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy, and/or excision of herniated intervertebral disc, 1 interspace, lumbar.
Summary
In layman's terms, this procedure is a minimally invasive surgery to relieve pressure on nerves in the lower back. It helps to remove parts of a damaged disc and other bone or tissue that may be compressing the spinal cord and nerve roots.
Purpose
This procedure addresses conditions like herniated discs, spinal stenosis, or other issues that cause nerve compression in the lumbar spine. The goal is to alleviate pain, numbness, and weakness in the lower back and legs, and to improve mobility and quality of life.
Indications
The procedure is indicated for patients experiencing:
- Severe lower back pain
- Sciatica or leg pain
- Numbness or weakness in the legs
- Failed conservative treatments like physical therapy or medications
- Diagnostic imaging showing nerve compression
Preparation
Patients are usually instructed to:
- Fast for at least 8 hours before the procedure
- Adjust or discontinue certain medications (e.g., blood thinners)
- Undergo pre-operative imaging tests such as MRI or CT scans
- Attend a pre-surgery consultation to discuss anesthesia and procedure details
Procedure Description
- Patient is positioned face-down on the operating table.
- General anesthesia or sedation is administered.
- A small incision is made above the affected lumbar area.
- An endoscope (a thin, flexible tube with a camera) is inserted through the incision.
- Using specialized tools, the surgeon performs laminotomy (removal of part of the vertebra), partial facetectomy (removal of part of the facet joint), and foraminotomy (expansion of the foramina through which nerves pass).
- The herniated part of the disc is excised or removed.
- The incision is closed with sutures or surgical glue.
Duration
The procedure typically takes around 1 to 2 hours.
Setting
The procedure is performed in a hospital operating room or a specialized outpatient surgical center.
Personnel
The healthcare team typically includes:
- An orthopedic surgeon or neurosurgeon
- An anesthesiologist
- Surgical nurses and technologists
Risks and Complications
Common risks include:
- Infection
- Bleeding
- Nerve damage
- Spinal fluid leak Rare complications might include:
- Persistent pain
- Recurrence of disc herniation
- Blood clots
Benefits
The expected benefits are significant reduction in pain and improved mobility. Most patients begin to experience relief a few days to weeks after the procedure.
Recovery
Post-procedure care includes:
- Limited activity for several weeks
- Prescription pain medication as needed
- Follow-up appointments to monitor healing
- Physical therapy to strengthen the back Recovery time varies; most patients return to normal activities within 4 to 6 weeks.
Alternatives
Alternative treatments may include:
- Conservative management (physical therapy, pain medications)
- Epidural steroid injections
- Open back surgery (more invasive) Compared to alternative treatments, endoscopic decompression is less invasive with quicker recovery times but may not be suitable for all patients.
Patient Experience
During the procedure, the patient is under anesthesia and should feel no pain. Post-procedure, patients may experience mild to moderate pain at the incision site, managed with medication. Comfort measures include rest, ice packs, and gradual re-introduction of activities.