Name of the Procedure:

Laminectomy for Biopsy/Excision of Intraspinal Neoplasm; Intradural, Intramedullary, Thoracolumbar

Summary

A laminectomy is a surgical procedure to remove part of the vertebral bone called the lamina. This specific procedure targets intradural and intramedullary tumors located in the thoracolumbar region of the spine. It's used to access and remove neoplasms (abnormal growths) in the spinal cord.

Purpose

This procedure aims to diagnose or remove spinal tumors that reside inside the spinal cord (intramedullary) and within the dura mater covering the spinal cord (intradural). The goals include relieving symptoms, preventing further neurological damage, and obtaining tissue samples for biopsy to determine the nature of the tumor.

Indications

• Persistent back pain unresponsive to other treatments
• Neurological deficits such as muscle weakness or numbness
• Difficulty walking or balance issues
• Loss of bowel or bladder control
• MRI or CT scan showing the presence of a spinal neoplasm

Preparation

• Fasting for at least 8 hours prior to the surgery
• Discontinuation of specific medications as instructed by the physician, especially blood thinners
• Preoperative imaging tests like MRI or CT scans to locate and assess the tumor
• Blood tests and physical examination

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the back over the affected thoracolumbar area.
3. The surgeon removes a portion of the lamina to access the spinal cord.
4. Intradural exposure is achieved by opening the dura mater.
5. The tumor is located and either biopsied or excised using microsurgical techniques.
6. The dura mater is closed, and the muscle and skin are sutured back together.

Tools and Equipment:

• Scalpels and surgical instruments
• Microsurgical instruments
• An operating microscope

Anesthesia:

• General anesthesia is administered to keep the patient unconscious and pain-free during the procedure.

Duration

The procedure typically takes 3 to 6 hours, depending on the tumor's size and location.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Neurosurgeon or orthopedic spine surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technologist

Risks and Complications

• Infection
• Bleeding
• Spinal fluid leakage
• Neurological damage such as paralysis or loss of sensation
• Post-operative pain
• Blood clots

Benefits

• Relief from pain and neurological symptoms
• Removal of tumor or obtaining tissue for diagnosis
• Prevention of further neurological deterioration

Recovery

• Hospital stay for observation, typically ranging from a few days to a week
• Pain management with medications
• Gradual return to activities with possible physical therapy
• Follow-up appointments to monitor recovery and any further treatment needs

Alternatives

• Conservative management with medications and physical therapy
• Radiation therapy or chemotherapy for certain types of tumors
• Stereotactic radiosurgery (non-invasive)

Pros and Cons:

• Conservative treatments may reduce symptoms temporarily but may not eliminate the tumor.
• Radiation and chemotherapy can shrink tumors but have side effects and may not be suitable for all tumor types.
• Stereotactic radiosurgery is non-invasive but not appropriate for all tumor locations.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel any pain. Post-operatively, patients may experience discomfort at the incision site, managed with pain medication. Mild to moderate pain, swelling, and a gradual improvement in symptoms can be expected over several weeks. Physical therapy might be necessary to aid rehabilitation and improve mobility.