Name of the Procedure:

Laminotomy (hemilaminectomy) with decompression of nerve root(s), including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar
Common name: Lumbar Laminotomy/Laminectomy

Summary

A lumbar laminotomy, also known as a hemilaminectomy, is a surgical procedure performed to relieve pressure on spinal nerve roots in the lower back. This is done by removing a portion of the lamina (a part of the vertebra), any herniated disc material, and possibly parts of the facet joints.

Purpose

This procedure addresses conditions causing nerve compression, such as herniated discs, spinal stenosis, or bone spurs. The goal is to alleviate symptoms like lower back pain, leg pain, numbness, and weakness by decompressing the affected nerve roots.

Indications

• Chronic lower back pain
• Sciatica or radiculopathy
• Herniated intervertebral disc
• Spinal stenosis
• Failure of conservative treatments (e.g., medications, physical therapy)

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments or temporary cessation of certain medications (e.g., blood thinners)
• Preoperative imaging tests such as MRI or CT scans

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A small incision is made in the patient's lower back.
3. Exposure: Muscles are moved aside to expose the vertebra.
4. Lamina Removal: A portion of the lamina is removed to access the spinal canal.
5. Nerve Decompression: The surgeon removes any herniated disc material and may excise part of the facet joint or perform a foraminotomy to further decompress the nerve.
6. Closure: The incision is closed with sutures or staples, and a sterile bandage is applied.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or surgical center.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Spinal fluid leak
• Recurrence of symptoms
• Anesthesia-related complications

Benefits

• Relief from lower back and leg pain
• Improved mobility and function
• Reduction in nerve-related symptoms like numbness and weakness
• Benefits are often realized within a few weeks post-surgery.

Recovery

• Short hospital stay (usually 1-2 days)
• Pain management with medications
• Physical therapy may be recommended
• Avoid heavy lifting and bending for several weeks
• Follow-up appointments to monitor healing

Alternatives

• Non-surgical treatments: physical therapy, medications, epidural steroid injections
• Other surgical options: Microdiscectomy, full laminectomy, spinal fusion
• Pros and cons: Non-surgical options may involve prolonged pain relief efforts; different surgical options might be more invasive or have longer recovery periods.

Patient Experience

• During the procedure: Under general anesthesia, so the patient will be unconscious and feel no pain.
• After the procedure: The patient may experience some discomfort and pain at the incision site, which can be managed with medication. Physical therapy and gradual return to activity are crucial for recovery. Pain relief and improved mobility are expected outcomes.