Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar
CPT4 code
Name of the Procedure:
Laminectomy for Biopsy/Excision of Intraspinal Neoplasm; Extradural, Lumbar
Summary
In a layman's terms, a laminectomy for biopsy or excision of an intraspinal neoplasm is a surgical procedure where part of the vertebra (the lamina) is removed to access a spinal tumor located outside the dura (the outer membrane covering the spinal cord) in the lumbar (lower back) region. This allows for the tumor to be examined or removed.
Purpose
Medical Condition
The procedure is performed to address intraspinal neoplasms (tumors within the spinal canal but outside the dura) that can cause symptoms such as pain, neurological deficits, or spinal cord compression.
Goals/Outcomes
- To obtain a tissue sample for biopsy to diagnose the type of tumor.
- To remove all or part of the tumor to relieve symptoms and prevent further neurological damage.
Indications
Symptoms/Conditions
- Persistent or severe back pain.
- Neurological symptoms such as weakness, numbness, or paralysis in the legs.
- Loss of bladder or bowel control.
- Confirmed diagnosis of an extradural lumbar spinal tumor.
Patient Criteria
- Evidence of a tumor in the lumbar spine that requires a definitive diagnosis or removal.
- Symptoms or imaging studies suggesting spinal cord compression.
Preparation
Instructions
- Fasting for at least 8 hours before the procedure.
- Adjustments or discontinuation of certain medications (e.g., blood thinners, anti-inflammatory drugs).
- Preoperative blood tests, imaging studies (MRI or CT scans), and possibly a spinal angiogram.
Procedure Description
- Anesthesia: General anesthesia is administered to put the patient to sleep.
- Incision: A surgical incision is made in the lower back to expose the affected vertebra.
- Laminectomy: The surgeon removes part of the lamina to access the spinal canal.
- Tumor Access: The spinal dura is carefully avoided as the tumor is located extradural.
- Biopsy/Excision: Depending on the goal, a tissue sample is taken, or the tumor is partially or completely excised using surgical tools such as scalpels and forceps.
- Closure: The surgical site is closed with sutures or staples, and a sterile dressing is applied.
Duration
The procedure typically takes 2 to 4 hours, depending on the complexity and size of the tumor.
Setting
Performed in a hospital operating room or a specialized surgical center equipped for spinal surgeries.
Personnel
- Neurosurgeon or orthopedic spine surgeon.
- Anesthesiologist.
- Surgical nurses and operating room technicians.
- Possibly a neurologist or oncologist for preoperative and postoperative consultation.
Risks and Complications
Common Risks
- Infection.
- Bleeding.
- Pain at the surgical site.
- Nerve injury.
Rare Complications
- Spinal fluid leak.
- Paralysis.
- Deep vein thrombosis (DVT).
Benefits
- Relief of symptoms such as pain and neurological deficits.
- Ability to obtain a definitive diagnosis through biopsy.
- Prevention of further spinal cord or nerve root compression.
Recovery
Post-Procedure Care
- Pain management with medications.
- Instructions on wound care and activity restrictions.
- Gradual return to normal activities as tolerated.
Recovery Time
- Initial recovery in the hospital for 2-4 days.
- Full recovery can take several weeks to months, with possible physical therapy.
Alternatives
Other Treatment Options
- Radiation therapy.
- Chemotherapy for certain types of tumors.
- Observation and regular monitoring if the tumor is small and asymptomatic.
Pros and Cons
- Alternative treatments may avoid surgery but might not provide immediate symptom relief or a definitive diagnosis.
Patient Experience
During Procedure
The patient is under general anesthesia and will not feel or be aware of the procedure.
After Procedure
- Postoperative pain managed with medications.
- Possible discomfort at the incision site.
- Gradual improvement in symptoms; physical therapy may be recommended.
- Close follow-up with healthcare providers for monitoring and further treatment as needed.