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), More than 2 Vertebral Segments; Thoracic

Summary

A laminectomy is a surgical procedure to relieve pressure on the spinal cord and nerves. In this specific case, the procedure is performed on the thoracic spine to alleviate symptoms caused by spinal stenosis. It involves removing a portion of the vertebra known as the lamina over more than two vertebral segments without involving additional techniques like facetectomy, foraminotomy, or discectomy.

Purpose

The laminectomy aims to address spinal stenosis, a condition where the spinal canal narrows, causing pressure on the spinal cord or nerves. The primary goal is to relieve pain, numbness, or weakness in the affected areas and improve overall mobility and function.

Indications

• Chronic pain or numbness in the back or legs
• Muscle weakness or difficulty walking
• Impaired bladder or bowel function
• Symptoms unresponsive to nonsurgical treatments such as physical therapy, medications, or spinal injections

Preparation

• Patients may be required to fast for several hours before the procedure.
• Medication adjustments, such as stopping blood thinners, may be necessary.
• Preoperative diagnostics may include MRI or CT scans, blood tests, and a thorough medical evaluation.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made in the middle of the back over the affected thoracic vertebrae.
3. Exposure: Muscles and tissues are gently moved aside to expose the spine.
4. Lamina Removal: The lamina (a part of the vertebra) over more than two vertebral segments is carefully removed to relieve pressure on the spinal cord and/or cauda equina.
5. Exploration and Decompression: The spinal cord and nerves are explored, and any additional compressive elements are addressed.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The surgery typically takes between 2 to 4 hours, depending on the number of vertebral segments involved and the complexity of the case.

Setting

The procedure is performed in a hospital's operating room under sterile conditions.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses and technical staff
• Potentially a surgical assistant or resident

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Spinal fluid leak
• Nerve damage or worsening symptoms
• Deep vein thrombosis (DVT)
• Anesthesia-related complications

Benefits

• Relief from pain, numbness, or weakness
• Improved mobility and function
• Enhanced quality of life
• The benefits are often noticeable within a few weeks post-surgery.

Recovery

• Postoperative care includes pain management, wound care, and physical therapy.
• Most patients can resume light activities within a few weeks but may need to avoid strenuous activities for several months.
• Follow-up appointments are crucial for monitoring recovery and addressing any concerns.

Alternatives

• Conservative management including physical therapy, medications, and epidural injections
• Lesser invasive surgical options like microdiscectomy or endoscopic decompression
• Pros and cons: Non-surgical treatments may be less effective for severe cases but have fewer risks compared to surgery.

Patient Experience

• Patients may experience pain and discomfort at the incision site post-surgery, which can be managed with medication.
• A hospital stay of 1-3 days is typical.
• Gradual improvement in symptoms; physical therapy can aid recovery.
• Long-term outcome depends on the severity of the preoperative condition and overall health.