Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, includ...
HCPCS code
Name of the Procedure:
Laminotomy (hemilaminectomy) with Decompression of Nerve Root(s), Partial Facetectomy, Foraminotomy, Excision of Herniated Intervertebral Disc, and Implantation of Bone Anchored Annular Closure Device (CPT Code: C9757).
Summary
This procedure, commonly referred to as a laminotomy or hemilaminectomy, involves the surgical removal of a portion of the vertebra, decompression of nerve roots, and excision of a herniated disc. It aims to relieve pressure on spinal nerves and includes the implantation of a specialized device to repair and support the affected area.
Purpose
This surgery addresses issues like herniated discs, spinal stenosis, sciatica, and other conditions causing nerve compression. The goal is to alleviate pain, restore function, and prevent further spinal damage by stabilizing the spinal column.
Indications
- Persistent back or leg pain due to herniated discs.
- Nerve compression causing numbness or weakness.
- Symptoms of spinal stenosis.
- Failed conservative treatments (e.g., medications, physical therapy).
- Weakness or loss of bowel/bladder control due to nerve compression.
Preparation
- Patients may be instructed to fast for a specified period before the procedure.
- Cease or adjust certain medications as advised by the physician.
- Undergo pre-operative imaging studies (e.g., MRI, X-rays) and blood tests.
- Discuss medical history and potential risks with the surgical team.
Procedure Description
- Anesthesia: The patient receives general anesthesia.
- Incision: A small incision is made at the affected vertebral level.
- Laminotomy: A portion of the vertebral lamina is removed to access the spinal canal.
- Decompression: Nerve roots are decompressed by removing bone or soft tissue causing compression.
- Partial Facetectomy and Foraminotomy: Partial removal of the facet joints and widening of the foraminal passage to further decompress the nerves.
- Excision of Herniated Disc: The protruding or fragmented disc material is excised.
- Repair: An annular closure device is implanted to repair the annular defect and support the spine.
- Closure: The incision is closed with sutures or staples.
Duration
The procedure typically takes 1.5 to 3 hours, depending on the complexity and the specific case.
Setting
The procedure is generally performed in a hospital or surgical center with facilities for spinal surgery.
Personnel
- Orthopedic or Neurosurgeon
- Surgical nurse
- Anesthesiologist
- Surgical technologist
Risks and Complications
- Infection
- Bleeding
- Nerve damage
- Spinal fluid leak
- Recurrence of symptoms
- Implant-related issues
Benefits
- Relief from chronic pain
- Improved mobility and function
- Reduction in nerve-related symptoms
- Stabilized spinal structure
Recovery
- Post-operative monitoring in the recovery room.
- Pain management with medications.
- Gradual return to normal activities, with specific instructions to avoid heavy lifting or strenuous activities.
- Follow-up appointments to monitor healing and progress.
Alternatives
- Physical therapy
- Pain management strategies (e.g., medications, injections)
- Less invasive procedures (e.g., microdiscectomy)
- Alternative surgeries (e.g., spinal fusion)
Each alternative has its pros and cons regarding effectiveness, recovery time, and potential risks.
Patient Experience
Patients might experience some discomfort and soreness post-surgery, but pain management strategies will be employed. The healthcare team will ensure the patient's comfort and provide guidance on activity levels and exercises to aid recovery.