Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracic
CPT4 code
Name of the Procedure:
Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracic
Summary
A thoracic laminectomy is a surgical procedure performed to remove a portion of the vertebral bone (the lamina) to access the spinal cord. This specific procedure targets the biopsy or removal of a tumor located within the spinal cord in the thoracic (middle) region of the back.
Purpose
This procedure addresses the presence of a tumor within the spinal cord. The primary goals are to obtain a biopsy to diagnose the type of tumor accurately or to excise (remove) the neoplasm completely to relieve symptoms and prevent further neurological damage.
Indications
- Persistent back pain not responsive to conservative treatments
- Neurological symptoms such as weakness, numbness, or paralysis
- Evidence of a spinal tumor from imaging studies (e.g., MRI, CT scan)
- Deteriorating neurological function
Preparation
- Patients are often required to fast for at least 8 hours before the procedure.
- Medication adjustments may be necessary, especially blood thinners.
- Preoperative labs and imaging studies will be conducted to plan the surgery.
- Instructions on bathing with antiseptic soap the night before may be provided.
Procedure Description
- Anesthesia: The patient is administered general anesthesia to ensure they are unconscious and pain-free.
- Positioning: The patient is positioned face down on the operating table.
- Incision: A surgical incision is made over the thoracic spine.
- Lamina Removal: The surgeon carefully removes part of the lamina to access the spinal cord.
- Tumor Access: The dura mater (a protective membrane) is opened to expose the tumor.
- Biopsy/Excision: The tumor is either biopsied for analysis or completely removed.
- Closure: The dura mater is closed, and the removed lamina may be replaced or left out. The incision is then sutured.
Special surgical tools such as microsurgical instruments and high-powered microscopes are used.
Duration
The procedure typically takes between 3 to 5 hours, depending on the complexity of the tumor.
Setting
The procedure is performed in a hospital operating room equipped with advanced surgical facilities.
Personnel
- Neurosurgeon or orthopedic spine surgeon
- Anesthesiologist
- Surgical nurses
- Surgical technologists
Risks and Complications
- Infection
- Bleeding
- Spinal fluid leakage
- Nerve or spinal cord injury
- Adverse reactions to anesthesia
- Postoperative pain and discomfort
- Rarely, paralysis or worsening neurological function
Benefits
- Relief from pain and neurological symptoms
- Potential complete removal of the tumor
- Prevention of further neurological deterioration
- Improved diagnosis through biopsy for targeted treatment
Recovery
- Initial recovery in the hospital for several days with close monitoring.
- Post-procedure instructions include limited physical activity, wound care, and possibly wearing a brace.
- Physical therapy may be recommended.
- Full recovery can take several weeks to months, with follow-up appointments to monitor progress.
Alternatives
- Radiation Therapy: Suitable for specific types of tumors but may not provide immediate symptom relief.
- Chemotherapy: Used for certain cancers but often as an adjunct to surgery.
- Observation: Monitoring the tumor with regular imaging tests if it is slow-growing or asymptomatic.
Each alternative carries its own risks and benefits, which would be discussed by the treating physician.
Patient Experience
Patients might experience some discomfort and pain post-surgery, usually managed through prescribed medications. They may need assistance with daily activities initially and should avoid strenuous activities until cleared by their healthcare provider. Pain and discomfort generally improve over time as healing progresses.