Name of the Procedure:

Laminectomy for Excision or Evacuation of Intraspinal Lesion Other Than Neoplasm, Extradural; Thoracic

Summary

A thoracic laminectomy is a surgical procedure aimed at relieving pressure on the spinal cord or nerves within the thoracic region (middle part) of the spine by removing a portion of the vertebral bone (lamina) to access and remove an intraspinal lesion. This type of procedure does not involve dealing with cancerous tumors.

Purpose

This procedure addresses medical conditions involving spinal cord compression due to non-cancerous lesions, such as a herniated disc, hematoma, or abscess. The primary goal is to alleviate pain, restore neurological function, and prevent further neurological deterioration.

Indications

• Severe back pain unresponsive to conservative treatments
• Neurological deficits such as weakness, numbness, or loss of bladder/bowel control
• Spinal infections, hematomas, or non-cancerous masses exerting pressure on spinal nerves

Preparation

• Fasting for 6-8 hours before surgery
• Discontinuation of certain medications as advised by the surgeon
• Preoperative imaging like MRI or CT scans to locate the lesion
• Blood tests and physical examination to assess overall health

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision over the affected thoracic vertebra.
3. Soft tissues and muscles are gently moved aside to expose the spine.
4. The lamina (part of the vertebra covering the spinal canal) is removed.
5. The lesion (e.g., herniated disc fragment, hematoma, or abscess) is carefully excised or evacuated.
6. The area is irrigated, and any remaining bone or tissue fragments are removed.
7. The incision is closed with sutures or staples.
8. A sterile dressing is applied.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the lesion.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Neurosurgeon or orthopedic spine surgeon
• Anesthesiologist
• Surgical nurses and technicians
• Post-operative care team

Risks and Complications

• Infection
• Bleeding or hematoma
• Spinal fluid leak
• Nerve injury
• Blood clots
• Anesthesia-related risks
• Post-operative chronic pain

Benefits

• Relief from severe back pain
• Improvement or restoration of neurological function
• Prevention of further neurological deterioration
• Improved quality of life

Recovery

• Hospital stay of 2-4 days post-surgery
• Pain management with medications
• Gradual increase in activity as tolerated
• Physical therapy may be required
• Full recovery typically takes 6-12 weeks
• Follow-up appointments to monitor healing

Alternatives

• Conservative treatments such as physical therapy, medications, or corticosteroid injections
• Minimally invasive spine surgery
• Pros: Less invasive alternatives have shorter recovery times but may not be effective for severe cases.
• Cons: Non-surgical options might not provide long-term relief or may fail to address severe neurological symptoms.

Patient Experience

• Patients will be under general anesthesia and asleep during the operation.
• Post-operative pain and discomfort will be managed with medications.
• A gradual reduction in back pain and improvement in neurological function can be expected.
• During recovery, patients may feel soreness at the incision site and limited mobility initially, with improvement over weeks.