Name of the Procedure:

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

Summary

A laminectomy is a surgical procedure where a portion of the vertebra (the lamina) is removed to access the spinal canal. This specific type is performed in the thoracic region of the spine to remove or biopsy a tumor located inside the spinal canal but outside the spinal cord.

Purpose

This procedure is used to diagnose or remove tumors located in the spinal canal but outside the spinal cord in the thoracic region. The main goals are to relieve pressure on the spinal cord and nerves, alleviate pain, improve or maintain neurological function, and obtain a tissue sample for cancer diagnosis.

Indications

• Persistent back pain not relieved by conservative treatments
• Neurological deficits such as weakness, numbness, or paralysis
• Diagnostic imaging (MRI or CT scan) showing an intraspinal tumor
• Symptoms of spinal cord compression

Preparation

• Pre-operative fasting typically required (usually after midnight before surgery)
• Medication adjustments as advised by the healthcare provider
• Pre-surgical imaging tests like MRI or CT scan to locate the tumor
• Blood tests and a physical examination to assess overall health

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision in the back over the involved thoracic vertebrae.
3. Muscles are moved aside to expose the spine.
4. The lamina (part of the vertebra) is removed to access the spinal canal.
5. The tumor is located and either biopsied or excised (removed).
6. The area is carefully closed with sutures after ensuring no bleeding and proper alignment.
7. A drainage tube may be placed to prevent fluid buildup.

Duration

The procedure typically lasts between 2 to 4 hours, but this can vary depending on the complexity of the case.

Setting

This procedure is performed in a hospital's operating room, often requiring an inpatient stay.

Personnel

• Neurosurgeon or orthopedic spine surgeon
• Anesthesiologist
• Surgical nurses and operating room staff
• Radiologist or pathology specialist (for biopsy analysis)

Risks and Complications

• Infection
• Bleeding
• Damage to the spinal cord or nerves
• CSF (cerebrospinal fluid) leak
• Blood clots
• Reactions to anesthesia
• Long-term back pain or instability

Benefits

• Relief from pain and other symptoms caused by the tumor
• Potential improvement or stabilization of neurological function
• Accurate diagnosis from biopsy tissue analysis

Recovery

• Hospital stay of a few days to a week
• Initial rest and limited movement
• Gradual return to normal activity over several weeks
• Pain management with prescribed medications
• Follow-up appointments for monitoring recovery and evaluating pathology results
• Possible physical therapy for full rehabilitation

Alternatives

• Non-surgical treatments like radiation or chemotherapy, depending on the tumor type
• Minimally invasive spinal surgeries where applicable
• Symptomatic control with medications

Pros and Cons of Alternatives

• Radiation/Chemotherapy: Less invasive but potentially less effective for immediate symptom relief.
• Symptomatic Control: May provide temporary relief without addressing the underlying cause.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel anything.
• Post-procedure, there will be discomfort from the incision and muscle manipulation, managed with pain medications.
• Gradual improvement in the severity of symptoms over several weeks.
• Some mobility restrictions and need for assistance during the initial recovery phase.