Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; thoracic
CPT4 code
Name of the Procedure:
Laminectomy, Facetectomy, and Foraminotomy (Unilateral or Bilateral with Decompression of Spinal Cord, Cauda Equina, and/or Nerve Root(s) [e.g., Spinal or Lateral Recess Stenosis]), Single Vertebral Segment; Thoracic
Summary
A laminectomy, facetectomy, and foraminotomy is a type of spinal surgery that relieves pressure on the spinal cord, cauda equina, and nerve roots in the thoracic (mid-back) region. It involves removing part of the vertebra and surrounding structures to decompress the affected nerves.
Purpose
This procedure addresses conditions like spinal stenosis or nerve compression in the thoracic spine. The goal is to relieve pain, numbness, and other symptoms by decompressing the affected nerves and improving spinal stability.
Indications
- Persistent thoracic back pain.
- Numbness or weakness in the legs or torso.
- Spinal stenosis or nerve compression diagnosed by imaging studies.
- Failed conservative treatments like physical therapy or medications.
Preparation
- Patients may need to fast for 6-8 hours before surgery.
- Adjustments to medications, particularly blood thinners, as advised by the healthcare provider.
- Pre-operative imaging tests (MRI, CT scans) and blood work.
Procedure Description
- The patient is positioned and administered general anesthesia.
- A small incision is made at the target vertebral segment.
- The surgeon removes part of the lamina, facet joint, and bone overlying the nerve root (laminectomy and facetectomy).
- The foramen (bony opening) is enlarged to ease nerve root passage (foraminotomy).
- Any herniated disc material or bone spurs that compress the nerves are removed.
- The incision is closed with sutures or staples.
Tools: Scalpel, retractors, surgical microscope, high-speed drill.
Anesthesia: General anesthesia.
Duration
Typically lasts between 2-4 hours, depending on the complexity.
Setting
Performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic or neurosurgeon.
- Anesthesiologist.
- Surgical nurses and assistants.
- Radiology technician (if intraoperative imaging is needed).
Risks and Complications
- Infection at the surgical site.
- Bleeding or hematoma formation.
- Nerve damage leading to numbness or weakness.
- Spinal fluid leak.
- Recurrence of symptoms.
- Possible need for additional surgery.
Benefits
- Pain relief in the thoracic region and improved mobility.
- Reduction in nerve compression symptoms like numbness or weakness.
- Typically, benefits can be noticed gradually over weeks to months post-surgery.
Recovery
- Hospital stay of 1-2 days post-surgery.
- Pain management with prescribed medications.
- Physical therapy may commence within a few weeks.
- Activity restrictions, such as avoiding heavy lifting or twisting motions, for several weeks.
- Follow-up appointments to monitor healing.
Alternatives
- Conservative treatments like physical therapy, chiropractic care, or epidural steroid injections.
- Minimally invasive spine decompression techniques.
- Pros and cons: Non-surgical treatments are less invasive but may offer only temporary relief and lesser efficacy. Minimally invasive surgery may involve a shorter recovery but is not suitable for all cases.
Patient Experience
During: The patient will be under general anesthesia and will not feel or remember the procedure.
After: Mild to moderate pain managed by medications. Some discomfort and limited mobility initially, improving with time and rehabilitation.