Laminectomy, with release of tethered spinal cord, lumbar
CPT4 code
Name of the Procedure:
Laminectomy with release of tethered spinal cord, lumbar
Summary
A laminectomy with release of the tethered spinal cord is a surgical procedure performed on the lower back (lumbar region) to alleviate abnormal stretching or tying down of the spinal cord, which can cause pain and neurological issues. The procedure involves removing part of the vertebral bone (lamina) and any structures tethering the spinal cord to relieve tension and improve symptoms.
Purpose
This surgery addresses conditions where the spinal cord is abnormally tethered, which can happen due to congenital spine defects, scar tissue from previous surgeries, or spinal trauma. The goals are to:
- Relieve back pain and leg pain
- Improve motor and sensory function
- Stop progressive neurological deterioration
Indications
- Symptoms like back pain, leg pain, or numbness
- Motor function loss or muscle weakness
- MRI or other imaging showing tethered spinal cord
- Failure of conservative treatments like physical therapy or medication
Preparation
- Fasting for at least 8 hours before the surgery
- Adjusting or stopping certain medications as advised by the doctor
- Undergoing pre-operative assessments like blood tests, MRI, or CT scans
- Arranging for post-surgery transportation and care
Procedure Description
- The patient is administered general anesthesia.
- An incision is made in the lower back over the affected vertebra.
- The surgeon removes the lamina to access the spinal canal.
- Any fibrous bands or tissues tethering the spinal cord are carefully released.
- The incision is closed with sutures or staples, and a sterile dressing is applied. Tools used include scalpels, retractors, surgical drills, and microscopes.
Duration
The procedure typically takes 2 to 4 hours, depending on complexity.
Setting
Performed in a hospital operating room.
Personnel
The surgical team includes:
- Spine surgeon (neurosurgeon or orthopedic surgeon)
- Anesthesiologist
- Surgical nurses
- Surgical technologists
Risks and Complications
- Common risks: Infection, bleeding, and reaction to anesthesia
- Rare risks: Spinal fluid leak, nerve damage, recurrence of tethering, paralysis
- Complications are managed with medication, additional surgeries, or other supportive treatments.
Benefits
- Relief from chronic back and leg pain
- Improved mobility and neurological function
- Halt in progressive neurological damage Full benefits are often realized within a few weeks to months post-surgery.
Recovery
- Post-operative hospital stay of 2-5 days
- Pain management with medications
- Avoid heavy lifting or strenuous activities for several weeks
- Follow-up appointments for wound check and physical therapy
- Gradual return to normal activities within 4-6 weeks
Alternatives
- Physical therapy
- Pain management strategies (medication, injections)
- Minimally invasive procedures Each alternative has differing effectiveness; surgical intervention is often the most definitive solution for severe tethering.
Patient Experience
- During the procedure: Will be under general anesthesia and will not feel pain.
- After the procedure: Expect some pain at the incision site, managed with medications.
- Gradual reduction in pre-existing pain and improvement in neurological symptoms.
- Follow-up care and possibly physical therapy to regain strength and function.