Name of the Procedure:

Laminectomy for Biopsy/Excision of Intraspinal Neoplasm; Extradural, Cervical

Summary

A laminectomy is a surgical procedure to remove a portion of the vertebral bone called the lamina. This specific procedure focuses on removing part of the cervical spine to either biopsy or excise an extradural tumor located within the spinal canal.

Purpose

This surgery aims to diagnose or remove a tumor in the cervical spine. It helps relieve pressure on the spinal cord or nerves caused by the tumor, potentially alleviating symptoms like pain, weakness, or numbness.

Indications

• Radiating neck or arm pain not relieved by conservative treatments.
• Neurological deficits such as muscle weakness, sensory loss, or bowel/bladder dysfunction.
• Progressive symptoms that suggest spinal cord or nerve root compression.
• Confirmed presence of an extradural tumor in the cervical spine through imaging studies.
• Biopsy needed to determine the nature of the neoplasm.

Preparation

• Fast for at least 8 hours prior to the procedure.
• Adjust medications as advised by the healthcare provider, especially blood thinners.
• Complete imaging tests like MRI or CT scans for surgical planning.
• Undergo pre-operative assessments, including blood tests and medical clearance.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A small incision is made in the back of your neck.
3. Exposure: Muscles and tissues are moved aside to expose the cervical vertebrae.
4. Lamina Removal: The lamina from the affected vertebrae is carefully removed.
5. Tumor Biopsy/Excision: The extradural tumor is either biopsied for diagnosis or completely removed.

6. Wound Closure: Muscles and tissues are repositioned, and the incision is closed with sutures or staples.

   Tools used commonly include surgical blades, retractors, drills, and microscopes.

Duration

The procedure typically lasts 2-4 hours, depending on the complexity and whether a biopsy or complete excision is performed.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Neurosurgeon or orthopedic spine surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologist

Risks and Complications

• Common: Infection, bleeding, pain at the surgical site, scarring.
• Rare: Spinal cord injury, nerve damage, cerebrospinal fluid leak, deep vein thrombosis, or adverse reaction to anesthesia.

Benefits

• Relief from symptoms caused by the tumor pressing on spinal nerves or the spinal cord.
• Improved neurological function if the tumor is compressing nerve tissue.
• Diagnostic information if a biopsy is performed.

Recovery

• Hospital stay: Typically 1-4 days, depending on recovery progress.
• Post-operative care: Pain management, wound care, physical therapy.
• Recovery time: Usually 4-6 weeks for basic recovery, but full recovery may take several months.
• Restrictions: Limited activity, avoid heavy lifting, driving, and strenuous activities until cleared by the surgeon.
• Follow-up: Scheduled appointments for wound check, suture removal, and progress assessment.

Alternatives

• Conservative treatments: Physical therapy, medications, or steroid injections.
• Non-surgical: Radiation therapy for specific types of tumors.
• Pros and Cons: Non-surgical methods are less invasive but may be less effective in relieving severe symptoms or removing certain types of tumors.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel or remember anything. Post-operatively, the patient may experience pain at the incision site, which can be managed with prescribed pain medications. Discomfort, swelling, and bruising are usual for a few weeks, and gradual improvement is expected with appropriate rehabilitation and care.