Name of the Procedure:

Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar

Summary

A laminectomy is a surgical procedure involving the removal of a portion of the vertebral bone called the lamina. This specific surgery focuses on removing or evacuating an intraspinal lesion located in the lumbar (lower back) region, which is not a tumor.

Purpose

This procedure addresses conditions such as abscesses, cysts, or hematomas in the lumbar spine that cause compression of the spinal cord or nerves. The goal is to relieve symptoms like pain, numbness, or weakness and to prevent further neurological deterioration.

Indications

• Persistent back pain not responsive to conservative treatments
• Neurological symptoms like numbness, tingling, or weakness in the legs
• Bladder or bowel dysfunction caused by spinal cord compression
• Diagnostic imaging showing an extradural lesion obstructing the spinal canal

Preparation

• Patients are typically advised to fast for at least 8 hours before the procedure.
• Certain medications, such as blood thinners, may need to be adjusted.
• Pre-operative diagnostic tests may include MRI or CT scans, blood tests, and a physical examination.

Procedure Description

1. The patient is administered general anesthesia to ensure they are asleep and pain-free.
2. The patient is positioned face down on the operating table.
3. A small incision is made in the skin over the affected vertebrae.
4. The surgeon moves muscles and tissues aside to access the spine.
5. The lamina, a part of the vertebra, is removed to expose the spinal cord and lesion.
6. The lesion is carefully excised or evacuated using specialized surgical tools.
7. The area is irrigated to ensure no debris or infection remains.
8. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes about 1 to 3 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
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Spinal fluid leakage
• Nerve damage
• Blood clots
• Recurrence of the lesion
• Persistent pain or symptoms

Benefits

Patients can expect pain relief and improved neurological function within days to weeks after the surgery. Long-term, the procedure can prevent further neurological issues and improve quality of life.

Recovery

• Initial recovery involves a short hospital stay (1-3 days).
• Pain management includes prescribed medications and possibly physical therapy.
• Patients may need to avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments will monitor healing and progress.

Alternatives

• Conservative treatments such as physical therapy, medications, or epidural injections
• Less invasive surgical options like microdiscectomy, if applicable
• Each alternative has its own set of risks and benefits; for instance, conservative treatments may delay immediate relief but avoid surgical risks.

Patient Experience

The patient will be under general anesthesia during the procedure and will not feel anything. Post-surgery, there may be discomfort at the incision site, manageable with pain medications. Physical therapy might be required to regain strength and mobility, and full recovery can take several weeks.