Name of the Procedure:

Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical.

Summary

A laminectomy for the biopsy or excision of an intraspinal neoplasm involves surgically removing a portion of the vertebral bone (lamina) to access and either biopsy or remove a tumor located within the spinal canal, but outside the spinal cord, specifically in the cervical (neck) region.

Purpose

This procedure addresses the presence of a tumor within the spinal canal that is intradural (within the dura mater) and extramedullary (outside the spinal cord). It aims to diagnose or treat the tumor, relieve symptoms such as pain or neurological deficits, and prevent further complications associated with the growth of the neoplasm.

Indications

• Persistent or severe neck pain
• Neurological deficits such as weakness, numbness, or loss of coordination
• Suspected or confirmed spinal tumors on imaging tests
• Compression of spinal nerves due to tumor growth

Preparation

• Patients may be required to fast for several hours before the procedure.
• Medication adjustments may be necessary, especially blood thinners.
• Pre-operative imaging studies like MRI or CT scans are often required to assess the tumor precisely.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the back of the neck to expose the vertebrae.
3. The surgeon removes a section of the lamina to access the spinal canal.
4. The tumor is then biopsied or excised based on the goal of the surgery.
5. The surgical site is closed with sutures or staples.
6. A drain may be placed to prevent fluid accumulation.

Duration

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

Setting

The procedure is performed in a hospital operating room.

Personnel

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

Risks and Complications

• Infection
• Bleeding
• Damage to spinal nerves or spinal cord leading to neurological deficits
• Spinal fluid leak (CSF leak)
• Post-surgical pain
• Anesthesia-related complications

Benefits

• Relief from pain and other neurological symptoms
• Prevention of further neurological deterioration
• Accurate diagnosis of the tumor

Recovery

• Initial hospital stay of a few days.
• Pain management with medications.
• Gradual return to daily activities with physical therapy.
• Follow-up appointments to monitor recovery and assess for any complications.
• Full recovery may take several weeks to months.

Alternatives

• Non-surgical options like radiation or chemotherapy (depending on tumor type).
• Less invasive procedures might not be as effective for certain tumors.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-operatively, there may be discomfort or pain at the surgical site, which will be managed with medications. Mobility may be temporarily limited, and physical therapy will aid in regaining strength and function.