Name of the Procedure:

Laminectomy with Exploration and/or Decompression of Spinal Cord and/or Cauda Equina, Without Facetectomy, Foraminotomy, or Discectomy (e.g., Spinal Stenosis), 1 or 2 Vertebral Segments; Cervical

Summary

A laminectomy is a surgical procedure where part of the bone (lamina) covering the spine is removed to relieve pressure on the spinal cord or nerves. This description pertains to a cervical laminectomy, focusing on one or two vertebral segments, aimed at addressing spinal stenosis without involving other spinal structures like facet joints or intervertebral discs.

Purpose

The purpose of this procedure is to alleviate pain, numbness, or weakness caused by compression of the spinal cord or nerve roots due to spinal stenosis. The goal is to improve mobility and reduce symptoms by decompressing the affected area in the cervical spine.

Indications

• Persistent pain in the neck, shoulders, or arms
• Numbness, tingling, or weakness in the upper extremities
• Difficulty with coordination or walking
• Diagnosis of cervical spinal stenosis on imaging studies
• Conservative treatments (like physical therapy or medications) have failed to relieve symptoms

Preparation

• Follow fasting instructions as provided by the healthcare team, typically nothing by mouth after midnight before the procedure.
• Inform your doctor about medications, especially blood thinners, as adjustments might be necessary.
• Preoperative imaging studies like X-rays, MRI, or CT scans to map the surgical site.
• A thorough medical evaluation to ensure fitness for surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A small incision is made at the back of the neck over the targeted vertebral segment(s).
3. Muscle Dissection: Soft tissues and muscles are gently moved aside to expose the vertebrae.
4. Lamina Removal: Using specialized surgical tools, the surgeon removes a portion of the lamina to relieve pressure.
5. Exploration & Decompression: The surgeon inspects the area, removing any ligament or tissue contributing to the compression.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and the number of segments involved.

Setting

Performed in a hospital or surgical center with access to specialized surgical equipment and anesthesia services.

Personnel

• Orthopedic or neurosurgeon specializing in spine surgery
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Blood clots
• Reaction to anesthesia
• Bleeding
• Damage to spinal cord or nerves
• Postoperative pain or stiffness
• Risk of recurrent symptoms

Benefits

• Relief of pain and pressure in the affected area
• Improved mobility and function
• Reduction in neurological symptoms such as weakness or numbness

Recovery

• Hospital stay for 1-2 days for monitoring
• Pain management with medications
• Wearing a cervical collar as directed
• Gradual return to activities over several weeks
• Follow-up appointments to monitor healing and progress
• Physical therapy may be recommended

Alternatives

• Conservative management with physical therapy, medications, and lifestyle modifications
• Epidural steroid injections
• Other surgical options like discectomy or foraminotomy if different structures are involved

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel any pain.
• Postoperative pain and discomfort are common, managed with pain medications.
• Temporary limitations on neck movements and lifting heavy objects.
• Gradual reduction in symptoms over weeks to months as healing progresses.