63011 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; sacral

Name of the Procedure:

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy, or discectomy. Common names include "Spinal decompression surgery" or "Laminectomy for spinal stenosis."

Summary

A laminectomy is a surgical procedure that involves removing part of the bone (the lamina) to relieve pressure on the spinal cord or cauda equina. This particular type of laminectomy focuses on the sacral region and does not include removal of the facet joints, foramina, or discs.

Purpose

The primary purpose of a laminectomy is to alleviate symptoms caused by spinal stenosis, including pain, numbness, and weakness. By removing part of the lamina, the procedure aims to create more space for the spinal cord or nerves, reducing their compression.

Indications

• Persistent pain in the lower back or legs.
• Numbness, tingling, or weakness in the legs.
• Difficulty walking or impaired balance.
• Bladder or bowel dysfunction due to nerve compression.
• Diagnosed spinal stenosis that has not responded to conservative treatments like physical therapy, medications, or injections.

Preparation

• Patients may need to fast for several hours before the surgery.
• Medications, especially blood thinners, may need to be adjusted.
• Preoperative tests might include MRI, CT scans, or X-rays to assess the spine’s condition.
• A preoperative assessment by the surgical team and anesthesiologist will be conducted.

Procedure Description

1. The patient is positioned face-down on the operating table.
2. General anesthesia is administered to ensure the patient is asleep and pain-free.
3. The surgeon makes an incision over the sacral area of the back.
4. Muscles are gently moved aside to expose the lamina of the affected vertebral segments.
5. A portion of the lamina is removed to relieve pressure on the spinal cord or cauda equina.
6. Any required exploration and decompression of the spinal cord or nerves is performed without removing facet joints, foramen, or discs.
7. The incision is closed with sutures or staples, and a dressing is applied.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity and number of segments involved.

Setting

Laminectomy is usually performed in a hospital's surgical suite or a specialized surgical center.

Personnel

• Orthopedic or Neurosurgeon
• Anesthesiologist
• Surgical nurses and assistants
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Excessive bleeding
• Blood clots
• Nerve damage leading to temporary or permanent weakness, numbness, or paralysis
• Spinal fluid leakage
• Reaction to anesthesia

Benefits

• Relief from chronic pain, numbness, and weakness
• Improved mobility and quality of life
• Reduced nerve compression providing symptom relief shortly after surgery

Recovery

• Patients may need to stay in the hospital for 1-2 days post-surgery.
• Pain management includes medications and possibly physical therapy.
• Initial recovery can take 4-6 weeks, with full recovery possibly extending to several months.
• Restrictions might include avoiding heavy lifting, bending, or twisting for several weeks.
• Follow-up appointments are necessary to monitor healing and progress.

Alternatives

• Conservative treatments: Physical therapy, medications, nerve block injections.
• Minimally invasive surgical options.
• Comprehensive rehabilitation programs.
• Each alternative has its pros and cons, often presenting lower immediate risks but potentially less effective long-term relief.

Patient Experience

• Under anesthesia, patients will not feel or remember the procedure.
• Postoperative pain and discomfort are manageable with medications.
• Physical therapy and gradual return to activity will aid recovery.
• Ongoing communication with healthcare providers will help manage pain and monitor progress.

This markdown text provides a comprehensive, yet layman-friendly, overview of the laminectomy procedure focused on the sacral vertebrae.