Name of the Procedure:

Laminotomy (Hemilaminectomy)

• Also known as Hemilaminectomy with Decompression of Nerve Root(s), Partial Facetectomy, Foraminotomy, and/or Excision of Herniated Intervertebral Disc
• Reexploration, Single Interspace; Each Additional Lumbar Interspace.

Summary

A laminotomy, or hemilaminectomy, is a surgical procedure designed to relieve pressure on the spinal cord or nerve roots in the lower back by removing a portion of the vertebral bone (lamina). This includes partial removal of the facet joints, widening of the foramen (pathways where nerves exit the spinal column), and potentially removing a herniated intervertebral disc.

Purpose

This procedure addresses conditions such as:

• Lumbar spinal stenosis (narrowing of the spinal canal).
• Herniated discs in the lumbar region.
• Compression of nerve roots causing pain, weakness, or numbness in the lower extremities. The goal is to relieve neurological symptoms, reduce pain, and improve mobility.

Indications

• Persistent pain, weakness, or numbness in the lower back and legs not responding to conservative treatments.
• Diagnosed lumbar spinal stenosis or herniated disc.
• Evidence of nerve root compression on imaging studies (MRI/CT).
• Patients with recurrent symptoms after initial surgery (reexploration).

Preparation

• Fasting for a specified period before surgery (usually 8-12 hours).
• Possible adjustments to medications (especially blood thinners).
• Preoperative imaging (MRI, CT scans) to precisely locate affected areas.
• Pre-surgical physical assessment and blood tests.

Procedure Description

1. Anesthesia: Patient is given general anesthesia.
2. Positioning: Patient is positioned face down on a surgical table.
3. Incision: A small incision is made over the affected vertebra.
4. Bone Removal: A portion of the lamina is removed to access the spinal canal.
5. Nerve Decompression: Partial facetectomy and foraminotomy are performed if necessary to relieve pressure on the nerve roots.
6. Disc Excision: If a herniated disc is present, the protruding portion is removed.
7. Reclosure: The incision is sutured closed.

Tools: Surgical instruments, possibly a microscope or endoscope for better visualization.

Duration

Typically, the procedure takes about 1-2 hours per lumbar interspace.

Setting

Performed in a hospital operating room or specialized surgical center.

Personnel

• Orthopedic or neurosurgeon.
• Anesthesiologist.
• Surgical nurses.
• Surgical technologist.

Risks and Complications

• Infection.
• Bleeding.
• Nerve damage.
• Spinal fluid leak.
• Recurrence of symptoms or additional herniation.
• Anesthesia-related complications.

Benefits

• Relief from pain and neurological symptoms.
• Improved mobility and quality of life.
• Benefits often seen within a few weeks post-surgery.

Recovery

• Initial hospital stay of 1-2 days.
• Pain management with medications.
• Gradual return to normal activities over several weeks.
• Physical therapy may be recommended.
• Follow-up appointments to monitor healing and progress.

Alternatives

• Conservative treatments: physical therapy, medications, epidural steroid injections.
• Other surgical options: laminectomy, spinal fusion.
• Pros of alternatives: Less invasive, shorter initial recovery period.
• Cons: May not be as effective for severe or persistent conditions.

Patient Experience

• During the procedure: Patient is under general anesthesia, will feel no pain.
• Post-procedure: Pain and discomfort managed with medications. Gradual improvement in symptoms.
• Initial soreness at the incision site, gradually decreasing over time.
• Physical therapy may be needed to regain full mobility and strength.