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; each additional segment, cervical, thoracic, or lu
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)), Single Vertebral Segment; Each Additional Segment, Cervical, Thoracic, or Lumbar. Commonly referred to as Spinal Decompression Surgery.
Summary
Spinal decompression surgery is performed to relieve pressure on the spinal cord, nerve roots, or cauda equina (a bundle of spinal nerves). It involves removing parts of the vertebrae, such as the lamina, facet joints, and foramen, to create more space and alleviate pain and other symptoms.
Purpose
The procedure addresses conditions causing spinal stenosis (narrowing of the spinal canal), such as herniated discs, bone spurs, or thickened ligaments. The goal is to reduce nerve compression and alleviate symptoms like pain, numbness, and weakness.
Indications
- Chronic back or neck pain
- Radiating pain to arms or legs (sciatica)
- Numbness, tingling, or weakness in the extremities
- Difficulty standing or walking due to nerve compression
- Spinal stenosis seen on imaging studies
Preparation
- Fasting for 6-8 hours before surgery
- Adjustments to medications, especially blood thinners
- Preoperative imaging such as MRI or CT scans
- Physical examination and medical history review
Procedure Description
- The patient is administered general anesthesia.
- A small incision is made over the affected vertebral segment.
- Muscles and tissues are gently moved aside to access the spine.
- The lamina, part of the facet joints, and the foramen are partially or fully removed to decompress the targeted nerves.
- The area is checked for any remaining compression.
- The incision is closed, and the patient is taken to recovery.
Tools: Surgical instruments such as retractors, drills, and rongeurs. Imaging guidance may be used. Anesthesia: General anesthesia is typically administered.
Duration
The procedure usually takes 1-3 hours, depending on the number of segments involved.
Setting
The surgery is performed in a hospital operating room or a surgical center.
Personnel
- Orthopedic or neurosurgeon
- Anesthesiologist
- Surgical nurses
- Operating room technician
Risks and Complications
- Infection
- Bleeding
- Nerve damage
- Spinal fluid leaks
- Blood clots
- Pain at the surgical site
- Recurrence of symptoms
Benefits
- Relief from chronic pain
- Improved mobility and function
- Reduced numbness and weakness
- Enhanced quality of life
- Benefits may be realized within a few weeks post-surgery.
Recovery
- Hospital stay of 1-3 days
- Pain management with medications
- Physical therapy for several weeks
- Restrictions on lifting and strenuous activities for 4-6 weeks
- Follow-up appointments to monitor healing and progress
Alternatives
- Nonsurgical options: Physical therapy, epidural steroid injections, medications
- Minimally invasive surgery: Microdiscectomy or endoscopic decompression
- Pros and cons vary; nonsurgical options may provide temporary relief, while minimally invasive surgery has shorter recovery but may not be suitable for severe cases.
Patient Experience
- During the procedure, the patient is under general anesthesia and will not feel pain.
- Post-surgery, patients may experience surgical site discomfort and will receive pain management.
- Gradual improvement in symptoms is expected, with full recovery typically taking a few weeks to a few months.