Name of the Procedure:

Laminectomy for Excision of Intraspinal Lesion Other Than Neoplasm, Intradural; Cervical

Summary

A laminectomy is a surgical procedure that involves removing a part of the vertebra called the lamina. This specific type of laminectomy targets lesions within the spinal canal in the cervical (neck) region, excluding tumors (neoplasms). The intent is to excise the lesion, relieve pressure on the spinal cord, and improve neurological function.

Purpose

A cervical laminectomy for excision of an intraspinal lesion is performed to address non-tumorous lesions within the spinal canal that are causing spinal cord compression. The goals of the surgery are to alleviate symptoms such as pain, numbness, weakness, or loss of function, and to prevent potentially severe neurological deficits.

Indications

• Persistent neck pain with radiating pain to the arms.
• Numbness or weakness in the arms or legs.
• Loss of coordination and motor skills.
• Evidence of an intraspinal lesion via imaging studies.
• Failure of conservative treatments like medications and physical therapy.

Preparation

• Patients may need to undergo pre-operative imaging studies (MRI, CT scans).
• Blood tests and other evaluations to ensure fitness for surgery.
• Fasting is typically required starting from midnight before the surgery.
• Instructions on medication adjustments may be provided, especially for blood thinners.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made in the midline of the back of the neck.
3. Surgical instruments are used to gently retract muscles to expose the cervical vertebrae.
4. The lamina is removed to provide access to the spinal canal.
5. The surgeon identifies and excises the lesion while carefully avoiding damage to the spinal cord and other structures.
6. The area is inspected to ensure all lesion material is removed.
7. The incision is closed with sutures or staples, and a sterile bandage is applied.

Duration

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

Setting

Laminectomies are generally performed in a hospital operating room or specialized surgical center.

Personnel

• Neurosurgeon or orthopedic spine surgeon.
• Anesthesiologist.
• Surgical nurses.
• Possibly a neurophysiologist to monitor spinal cord function during the procedure.

Risks and Complications

• Infection.
• Bleeding or hematoma.
• Spinal fluid leak.
• Nerve damage or spinal cord injury.
• Postoperative pain or stiffness.
• In rare cases, paralysis.

Benefits

• Relief from pain and neurological symptoms.
• Improved ability to move and function.
• Prevention of further neurological deterioration.
• Benefits may be noticeable immediately or within a few weeks post-surgery.

Recovery

• Initial hospital stay for 1 to 3 days for monitoring.
• Pain management with prescribed medications.
• Gradual return to normal activities with physical therapy.
• Restrictions on heavy lifting and vigorous activities for several weeks.
• Follow-up appointments to track healing and recovery progress.

Alternatives

• Conservative treatments such as physical therapy, medications, or spinal injections.
• Minimally invasive procedures, if deemed appropriate.
• The choice of treatment depends on the severity of the condition and the patient's overall health.

Patient Experience

• During the procedure, patients are under general anesthesia and will not feel pain.
• Postoperative discomfort and pain are managed with medications.
• Experiencing some stiffness and limited mobility initially is normal.
• Gradual improvement in symptoms can be expected as recovery progresses.