63005 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis

Name of the Procedure:

Laminectomy with Exploration and/or Decompression of Spinal Cord and/or Cauda Equina (Lumbar)

Summary

A laminectomy is a surgical procedure that removes a portion of the vertebral bone called the lamina to relieve pressure on the spinal cord and/or cauda equina. This procedure addresses issues such as spinal stenosis, typically without involving facetectomy, foraminotomy, or discectomy.

Purpose

A laminectomy is primarily performed to alleviate pain, numbness, and weakness caused by compressed nerves in the lumbar spine. The main goal is to decompress the spinal cord or cauda equina, thereby providing relief from symptomatic spinal stenosis.

Indications

• Chronic lower back pain
• Leg pain (sciatica)
• Numbness, tingling, or muscle weakness in the legs
• Difficulty walking or reduced walking endurance
• Loss of bowel or bladder control (severe cases)

Preparation

• Patients may be asked to fast for 6-12 hours before the procedure.
• Medication adjustments, particularly blood thinners, need to be managed.
• Pre-operative tests such as MRI, X-rays, or CT scans may be required to assess the extent of spinal compression and plan the procedure.

Procedure Description

1. The patient is positioned face down and administered general anesthesia.
2. A small incision is made over the affected vertebral segment(s).
3. Muscles and tissues are moved aside to access the spine.
4. The lamina of the vertebra is carefully removed using surgical instruments.
5. The surgical site is explored, and any compressive elements are removed or adjusted to decompress the spinal cord or cauda equina.
6. The incision is closed with sutures, and the area is bandaged.

Duration

The procedure typically takes 1-3 hours, depending on the number of vertebral segments involved.

Setting

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

Personnel

• Orthopedic Surgeon or Neurosurgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Spinal fluid leak
• Blood clots
• Recurrence of symptoms
• Adverse reaction to anesthesia

Benefits

• Reduced pain and improved mobility
• Relief from symptoms such as numbness and weakness
• Enhances quality of life
• Benefits may be realized within weeks after surgery

Recovery

• Patients may stay in the hospital for 1-3 days post-operation.
• Limited physical activity for several weeks.
• Physical therapy may be recommended.
• Surgical site care and follow-up appointments to monitor healing.
• Full recovery typically takes 4-6 weeks, with gradual return to normal activities.

Alternatives

• Physical therapy
• Medications (e.g., anti-inflammatories, pain relievers)
• Epidural steroid injections
• Less invasive procedures like endoscopic spine surgery
• Pros of alternatives: Less invasive, shorter recovery time
• Cons: May not be as effective for severe compression

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel anything.
• Post-operative pain at the incision site, managed with medications.
• Possible discomfort due to limited mobility and need for activity restrictions.
• Gradual improvement in symptoms with proper care and rehabilitation.