Background Information:

What are the other Names for the Procedure?

• Full Lumbar Laminectomy
• Lumbar Spinal Decompression
• Partial Lumbar Laminectomy

What is Lumbar Laminectomy and Rhizolysis surgical procedure?

• The spinal cord runs through a spinal canal formed by the body (the thick bulk of the vertebral bone), the laminae, the spine, and the intervertebral discs (shock absorbers between the vertebral bones)
• Lumbar Laminectomy is a procedure that is done to relieve compression on the spinal cord or the spinal nerves by widening the spinal canal through removal of the laminae at the lumbar level of the spine.
• Rhizolysis procedure involves using a special probe to inactivate the nerve that sends pain signals into the spinal cord

What part of the Body does the Procedure involve?

The Lumbar Laminectomy and Rhizolysis procedure involves the spine in the lower back and the overlying tissues.

Why is the Lumbar Laminectomy and Rhizolysis surgical procedure Performed?

Lumbar Laminectomy and Rhizolysis is performed for the following reason:

• Spinal stenosis (narrowing of the spinal canal)
• This may lead to pain and weakness in the legs and bladder or bowel signs and symptoms

What are some Alternative Choices for the Procedure?

Alternative choices to Lumbar Laminectomy and Rhizolysis include surgical procedures such as:

• Lumbar foraminotomy, where more space is made around the nerves by removing the bone at the site of nerve exit from the spine
• Lumbar laminotomy, which is performed by removing a small portion of the lamina of the vertebral bone

What are the Recent Advances in the Procedure?

The instrumentation used to perform the surgery has undergone further advancement.

What is the Cost of performing the Lumbar Laminectomy and Rhizolysis surgical procedure?

The cost of Lumbar Laminectomy and Rhizolysis procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding a Lumbar Laminectomy and Rhizolysis and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.mayfieldclinic.com/PE-Decompression.htm#.VIHsDmdgrtA (accessed on 05/15/2015)

http://www.nlm.nih.gov/medlineplus/ency/article/007389.htm (accessed on 05/15/2015)

http://www.spinal-care.co.uk/rhizolysis/ (accessed on 05/15/2015)

Prior to Lumbar Laminectomy and Rhizolysis surgical procedure:

How is the  Lumbar Laminectomy and Rhizolysis surgical procedure Performed?

The Lumbar Laminectomy and Rhizolysis procedure is performed under general anesthesia.

• The surgeon makes an incision on the middle of the lower back overlying the diseased vertebral bones
• The tissues and muscles covering the spine are cut and displaced
• The surgeon then removes the spinal laminae (sheet-like projections that arise from the body of the vertebra on either side) and the spine (the laminae fuse at their ends to form a projection called the spine) to free up the pressure on the spinal cord
• Additional soft tissue and bony fragments that may have been causing compression is also removed
• The surgeon may use a special probe to produce heat that can inactivate the nerves that send pain signals into the spinal cord. This is called Rhizolysis. Alternatively, this may be done using imaging techniques to identify the nerve location and by passing the probe through the skin under local anesthesia
• Any displaced tissues are set back in place, and the skin incision is sutured

Where is the Procedure Performed?

A Lumbar Laminectomy and Rhizolysis procedure is performed in a hospital.

Who Performs the Procedure?

A Lumbar Laminectomy and Rhizolysis procedure is performed by any of the following medical personnel, with or without assistance from an anesthesiologist:

• A neurosurgeon
• An orthopedic surgeon
• A spine surgeon

How long will the Procedure take?

The procedure may usually be completed in 1-3 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Lumbar Laminectomy and Rhizolysis procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Lumbar Laminectomy and Rhizolysis procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Lumbar Laminectomy and Rhizolysis surgical procedure?

Before a Lumbar Laminectomy and Rhizolysis procedure, the patient has to undergo certain tests such as:

• MRI/CT of the lower back
• Routine blood and urine analysis
• EKG
• Chest X-ray

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Lumbar Laminectomy and Rhizolysis surgical procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• What are the costs involved?

During the Lumbar Laminectomy and Rhizolysis surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is administered for this procedure.

How much Blood will you lose, during the Procedure?

The blood loss during an uncomplicated Lumbar Laminectomy and Rhizolysis procedure is not significant.

What are the possible Risks and Complications during the Lumbar Laminectomy and Rhizolysis surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Lumbar Laminectomy and Rhizolysis surgery are:

• Excessive bleeding
• Infection within the surgical wound
• Anesthetic complications
• Accidental injury to the nerves, leading to a loss of specific functions
• Leakage of cerebrospinal fluid

What Post-Operative Care is needed at the Healthcare Facility after the Lumbar Laminectomy and Rhizolysis surgical procedure?

• After the Lumbar Laminectomy and Rhizolysis procedure, the patients are sent to an area of the hospital called the postoperative recovery area (or PACU)
• The patient’s blood pressure, heart rate, and respiration cycle shall be closely monitored. Any additional pain associated with the procedure will be treated
• Individuals are usually discharged from the hospital after a stay of 1-2 days if there are no complications

After the Lumbar Laminectomy and Rhizolysis surgical procedure:

What are the possible Risks and Complications after the Lumbar Laminectomy and Rhizolysis surgical procedure?

The possible risks and complications that may arise after a Lumbar Laminectomy and Rhizolysis procedure are:

• Excessive bleeding
• Infection within surgical wound
• Persistence or progression of the symptoms
• Recurrent nerve compression

What is the Prognosis after the Surgery?

The prognosis after a Lumbar Laminectomy and Rhizolysis procedure is good. The surgery helps in pain relief in a vast majority of individuals, as well as improves symptoms of weakness.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness such as nausea, vomiting, abdominal swelling, or constipation
• Signs of an infection
• Headache, muscle aches
• Fever, feeling sick
• Dizziness
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Lumbar Laminectomy and Rhizolysis surgical procedure?

At home, the following post-operative care is recommended after a Lumbar Laminectomy and Rhizolysis procedure:

• Slowly resume regular/daily activities as early as possible, which aids in faster recovery
• It may be necessary to wear a brace. Do enquire with your physician about this
• Physical therapy should be done as advised by your physician
• Use a heat pad or warm compress to relieve pain due to the incision
• Resume showering a few days after surgery, and keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with mild or unscented soap
• Replace the dressings on the surgical wound after showering
• Maintain good posture and avoid lifting of heavy weights. Avoid sitting for prolonged time period and turning or bending at the waist for a few weeks
• Avoid driving for at least two to four weeks after the procedure, as advised by your physician
• Complete the course of prescribed medication under advice of the physician
• Take antibiotic medication to help combat or prevent infection, per your physician’s advice
• Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)

How long does it normally take to fully recover, from the Procedure?

Complete recovery from the Lumbar Laminectomy and Rhizolysis procedure may take up to two months or longer.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Generally, the tissue is not sent on a routine basis for tests. However, if a surgeon decides to have the tissue examined; then, it is sent to a laboratory for a pathology examination.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Usually, a pathologist does not get involved in the care of the patient. However, if a tissue is received for further lab analysis, then:

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Lumbar Laminectomy and Rhizolysis surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist (if anesthesia was administered)
• An orthopedic surgeon/ spine surgeon/neurosurgeon

The patient is advised to inquire and confirm the type of billing, before the Lumbar Laminectomy and Rhizolysis and Fusion surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA