Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional cervical interspace (List separately in addi
CPT4 code
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; each additional cervical interspace (List separately in addition).
Summary
A laminotomy, also known as a hemilaminectomy, is a surgical procedure performed on the spine to relieve pressure on nerve roots. This procedure involves removing a portion of a vertebra, which may include the facet joints and disc material, particularly if reexploring a previously operated site.
Purpose
The procedure targets conditions such as cervical spinal stenosis, herniated discs, or other compressive causes that affect the cervical spine. The goal is to relieve pain, numbness, and weakness by decompression of the affected nerve roots, restoring normal function and reducing symptoms.
Indications
- Persistent and severe neck pain
- Numbness or weakness in the arms or hands
- Cervical spinal stenosis
- Herniated cervical discs
- Failed previous cervical spine surgery requiring reexploration
- Ineffective non-surgical treatments
Preparation
- Fasting for 8-12 hours prior to the procedure.
- Adjustments or cessation of certain medications, as advised by the healthcare provider.
- Preoperative imaging (MRI or CT scans) to determine the exact location of nerve compression.
- General health assessments, including blood tests and cardiac evaluations.
Procedure Description
- Patient is administered general anesthesia.
- A small incision is made over the affected cervical spine region.
- Specialized surgical instruments are used to remove a portion of the vertebra (laminotomy/hemilaminectomy).
- Partial facetectomy and foraminotomy may be performed to gain access and decompress the nerve roots.
- Herniated disc material is excised if present.
- The site is carefully reexplored, particularly if previous surgeries have been performed.
- Incision is closed with sutures or staples, and a dressing is applied.
Duration
Typically, this procedure lasts between 2-4 hours. The time may vary depending on the complexity and number of interspaces involved.
Setting
Performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic spine surgeon or neurosurgeon
- Anesthesiologist
- Surgical nurses and assistants
- Radiologic technologist (if intraoperative imaging is used)
Risks and Complications
- Infection
- Bleeding
- Nerve damage or persistent nerve pain
- Spinal fluid leak
- Recurrence of symptoms or need for further surgery
- Anesthesia-related complications
Benefits
- Relief from chronic pain, numbness, and weakness
- Improved neck function and mobility
- Enhanced quality of life as symptoms diminish
- Most patients notice improvements within weeks post-surgery.
Recovery
- Hospital stay of 1-3 days post-surgery.
- Pain management through prescribed medications.
- Physical therapy may be recommended to aid recovery.
- Avoid heavy lifting and strenuous activity for several weeks.
- Follow-up appointments for wound check and imaging if necessary.
Alternatives
- Physical therapy and exercise programs
- Medications (pain relievers, anti-inflammatories)
- Epidural steroid injections
- Other surgical options like discectomy or spinal fusion
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel any pain. Post-operatively, pain management is a priority, and patients are provided medications to manage discomfort. Some may experience mild soreness at the incision site, but serious pain is uncommon. Comfort measures include rest, gentle movement, and use of ice packs or heat as advised by healthcare providers.