Name of the Procedure:

Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic

Summary

A laminectomy is a surgical procedure involving the removal of a portion of a vertebra, called the lamina, to gain access to the spinal canal. This specific procedure is performed to biopsy or remove tumors located outside the dura mater (the thick membrane covering the spinal cord) in the thoracic (mid-back) region.

Purpose

This surgery is conducted to diagnose or excise neoplasms (tumors) within the spinal canal but outside the dura mater in the thoracic region. The goal is to relieve symptoms, prevent further neurological damage, and confirm the nature of the tumor through biopsy.

Indications

• Persistent back pain localized to the thoracic area
• Neurological deficits such as weakness, numbness, or paralysis
• Failure of non-surgical treatments (e.g., medications, physical therapy)
• Imaging studies (MRI, CT) indicating the presence of a spinal tumor

Preparation

• Fasting for at least 8 hours before surgery
• Adjustments or temporary discontinuation of certain medications (e.g., blood thinners)
• Pre-operative imaging tests (MRI, CT scans)
• Blood tests and physical examination
• Discussion of medical history and any potential allergies

Procedure Description

1. Patient is positioned on their stomach (prone position) on the operating table.
2. General anesthesia is administered to ensure the patient is unconscious and pain-free.
3. A surgical incision is made over the affected vertebra in the thoracic spine.
4. The lamina (part of the vertebral arch) is removed to expose the spinal canal.
5. The extradural neoplasm is carefully biopsied or excised.
6. The area is inspected to ensure complete removal if possible.
7. The surgical site is closed with sutures or staples.
8. A sterile bandage is applied to protect the incision.

Duration

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

Setting

This procedure is performed in a hospital operating room.

Personnel

• Neurosurgeon or orthopedic spine surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection at the surgical site
• Excessive bleeding
• Damage to spinal nerves, resulting in temporary or permanent neurological deficits
• Spinal instability, potentially requiring additional surgery
• Adverse reactions to anesthesia
• Blood clots (deep vein thrombosis, pulmonary embolism)

Benefits

• Relief from symptoms caused by the tumor, such as pain and neurological deficits
• Improved or restored neurological function
• Accurate diagnosis through biopsy, aiding in further treatment planning
• Potential removal of the tumor, reducing the risk of further complications

Recovery

• Hospital stay for several days post-surgery for monitoring and pain management
• Gradual return to normal activities over 4 to 6 weeks
• Physical therapy to aid in recovery and strengthen the back muscles
• Follow-up appointments to monitor healing and assess for any complications
• Restrictions on heavy lifting and strenuous activities for several weeks

Alternatives

• Radiation therapy or chemotherapy
• Stereotactic radiosurgery
• Observation and regular monitoring through imaging
• Pain management with medications and physical therapy

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Post-surgery, there may be pain and discomfort at the incision site, managed with pain medications. There may also be some initial difficulty in moving and performing daily activities, requiring assistance and physical therapy. Most patients begin to see improvement in their symptoms within a few weeks as they recover.