Name of the Procedure:

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

Summary

A laminectomy procedure for the sacral spine involves surgically removing part of the vertebra to access and remove or evacuate an intraspinal lesion other than a tumor. This procedure relieves pressure on the spinal cord or nerves.

Purpose

The primary purpose of this procedure is to alleviate symptoms caused by an intraspinal lesion, such as pain, numbness, or weakness. The goal is to restore normal spinal function and improve quality of life.

Indications

This procedure might be indicated for patients experiencing:

• Persistent sacral pain unresponsive to conservative treatments
• Neurological deficits (e.g., numbness, tingling, weakness in the lower extremities)
• Impaired bladder or bowel function
• Confirmed diagnosis of an extradural intraspinal lesion via imaging studies

Preparation

• Patients may be required to fast for a specific period before the procedure.
• Medication adjustments may be necessary, particularly blood thinners.
• Pre-operative imaging such as MRI or CT scans will likely be performed.
• Discussions with the surgeon and anesthesiologist to finalize the surgical plan and anesthesia choices.

Procedure Description

1. Administration of general anesthesia to ensure the patient is asleep and pain-free.
2. Patient is positioned prone (lying on the abdomen) on the operating table.
3. A small incision is made over the sacral spine.
4. Muscles are gently moved aside to expose the vertebra.
5. Part of the lamina (the bony arch of the vertebra) is removed to access the spinal canal.
6. The lesion is carefully excised or evacuated.
7. Hemostasis is ensured, and the surgical site is closed with sutures or staples.
8. Sterile dressings are applied.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity and size of the lesion.

Setting

This surgery is performed in a hospital operating room or a specialized surgical center.

Personnel

The procedure involves:

• A spinal surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a surgical technician

Risks and Complications

Common and rare risks include:

• Infection
• Bleeding
• Spinal cord or nerve damage
• CSF (cerebrospinal fluid) leak
• Blood clots
• Anesthesia-related complications

Benefits

The main benefits are pain relief, improved mobility, and the resolution of neurological symptoms. These benefits can often be seen shortly after recovery from surgery.

Recovery

• Post-operative care includes pain management, wound care, and physical therapy.
• Hospital stay of 1 to 2 days may be required.
• Full recovery may take several weeks to months.
• Patients may need to avoid heavy lifting and strenuous activities during the recovery period.
• Follow-up appointments are necessary to monitor healing and progress.

Alternatives

• Conservative treatments such as physical therapy, medications, and epidural steroid injections.
• Minimally invasive surgical options, if appropriate.
• The choice of alternative depends on the specific condition and overall health of the patient.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Post-operatively, there may be discomfort at the incision site, managed with prescribed pain medications. Physical therapy and follow-up care are critical in ensuring a smooth and effective recovery.