Name of the Procedure:

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

Summary

In a laminectomy for biopsy/excision of an intradural, extramedullary lumbar neoplasm, surgeons remove a portion of the vertebral bone called the lamina. This gives them access to the spinal canal to remove a tumor located within the dura mater but outside the spinal cord. The procedure involves examining or taking a sample of the tumor for diagnosis and possibly excising it to relieve symptoms or prevent further complications.

Purpose

This procedure addresses intraspinal tumors that are located within the dural sheath but outside the spinal cord, specifically in the lumbar region. It aims to:

• Diagnose the nature of the spinal tumor (benign or malignant).
• Remove the tumor to alleviate symptoms such as pain, weakness, or neurological deficits caused by the tumor pressing on the spinal cord or nerves.
• Prevent the progression of neurological damage.

Indications

• Persistent or severe back pain unresponsive to conservative treatment.
• Neurological symptoms such as weakness, numbness, or loss of bowel/bladder control.
• Radiologic evidence of an intradural, extramedullary lumbar tumor.
• Progressive neurological deficits.
• Need for a definitive diagnosis when imaging is inconclusive.

Preparation

• Patients are usually instructed to fast for 8-12 hours before surgery.
• Medications, especially blood thinners, may need to be adjusted or discontinued several days prior to the procedure.
• Preoperative testing may include MRI or CT scans of the spine, blood tests, and physical examinations.
• Patients will be advised to arrange for postoperative help and transportation as mobility may be restricted initially.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia to ensure they are unconscious and pain-free.
2. Positioning: The patient is positioned face down on the operating table.
3. Incision: An incision is made in the lower back over the affected vertebra.
4. Laminectomy: A part of the lamina (vertebral bone) is removed to access the spinal canal.
5. Tumor Biopsy/Excision: The dura mater is carefully opened, and the tumor is identified. A sample may be taken for biopsy, or the whole tumor is excised if possible.
6. Closure: The dura is then meticulously closed, followed by the closure of the incision with sutures or staples.
7. Postoperative Care: The wound is dressed, and the patient is taken to recovery.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and specifics of the case.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Neurosurgeon or orthopedic spinal surgeon.
• Anesthesiologist.
• Surgical nurses and operating room technicians.

Risks and Complications

• Infection.
• Bleeding.
• Cerebrospinal fluid leakage.
• Dural tear.
• Nerve damage leading to weakness or paralysis.
• Persistent pain.
• Reaction to anesthesia.

Benefits

• Accurate diagnosis of the spinal tumor.
• Relief from chronic pain and neurological symptoms.
• Prevention of further neurological deterioration.
• Potential improvement in quality of life.

Recovery

• Hospital Stay: Generally, 3 to 5 days.
• Pain Management: Pain medications will be provided as needed.
• Activity Restrictions: Avoid heavy lifting, bending, or twisting for several weeks.
• Physical Therapy: Often recommended to aid recovery.
• Follow-up: Regular follow-up appointments for wound check and to monitor recovery.

Alternatives

• Observation with regular imaging if the tumor is asymptomatic and slow-growing.
• Stereotactic radiosurgery or radiation therapy.
• Chemotherapy if the tumor is malignant and responsive to such treatments.
• Pros and Cons: Less invasive but may not be as definitive in diagnosis or tumor removal as surgery.

Patient Experience

• During: Patient will be under general anesthesia and will not feel or remember the procedure.
• After: Postoperative pain managed with medications. Possible temporary numbness or weakness as nerves recover.
• Follow-Up: Regular consultations to monitor recovery and check for any complications. Physical therapy for rehabilitation is common.