What are the other Names for the Procedure?
- Decompression Surgery of the Vertebral Disc
- Decompressive Laminectomy
What is the Vertebral Disk Removal of Spine surgical procedure?
- Vertebral Disk Removal (Laminectomy) is an orthopedic surgical procedure where the whole or a part of the lamina is removed, from a vertebra
- Lamina is the dorsal or back part of the vertebrae that helps form the central canal, through which the spinal cord passes
What part of the Body does the Procedure involve?
The parts of the body involved in a Vertebral Disk Removal (Laminectomy) procedure are the vertebral disk and spine.
Why is the Vertebral Disk Removal of Spine surgical procedure Performed?
A Vertebral Disk Removal (Laminectomy) procedure is performed to relieve pressure and pain on the nerves and/or the spinal cord.
What are some Alternative Choices for the Procedure?
Alternatives to the procedure are physiotherapy and medication. However, if these treatments prove ineffective, then Disk Removal or Laminectomy remains as the only alternative.
What are the Recent Advances in the Procedure?
The recent advance in the procedure is in the use of laparoscopic techniques, which is referred to as Endoscopic spine surgery.
What is the Cost of performing the Vertebral Disk Removal of Spine surgical procedure?
The cost of Vertebral Disk Removal (Laminectomy) 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 with a sudden inflow of information regarding procedure and what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending 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.nlm.nih.gov/medlineplus/ency/article/007389.htm (accessed on 8th August, 2012)
http://www.mayoclinic.com/health/laminectomy/MY00674/DSECTION=risks (accessed on 8th August, 2012)
http://www.laserspineinstitute.com/spinal_orthopedic_procedures/spinal_fusion/ (accessed on 8th August, 2012)
Prior to Vertebral Disk Removal of Spine surgical procedure:
How is the Vertebral Disk Removal of Spine surgical procedure Performed?
- During the surgery an incision is made over the affected area where the protrusion of the disk is found
- In order to examine and isolate the protrusion and locate the exact point where it is causing pressure on the nerves or spinal cord, the surgeon cuts out the arches of the vertebrae
- Next, the surgeon isolates and removes the part of the disk causing the problem and closes the incision with sutures
- Sometimes, the surgeon may consider replacing the removed portion with a piece of bone obtained from the hip of the patient. This is called as bone fusion, in which case, further surgery is required
Where is the Procedure Performed?
A Vertebral Disk Removal (Laminectomy) procedure is performed in a hospital. The patient is admitted, undergoes the procedure and is discharged as per the instruction of the physician.
Who Performs the Procedure?
The procedure is performed either by a neurosurgeon or orthopedic surgeon along with an anesthesiologist.
How long will the Procedure take?
The procedure may take anywhere between 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 surgical 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, like 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?
- No particular preparations are needed prior to the procedure
- However, 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 being currently 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
- Avoid application of any cosmetics, 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 persons 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
- A physician will request your consent for Vertebral Disk Removal (Laminectomy) procedure using an Informed Consent Form.
What is the Consent Process before the Procedure?
A physician will request your consent for the Vertebral Disk Removal (Laminectomy) 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 Vertebral Disk Removal of Spine surgical procedure?
Before a Vertebral Disk Removal (Laminectomy) procedure is performed, the patient has to undergo certain tests such as:
- Routine blood and urine analysis
- X-ray of the back and lungs
- CT Scan
- ECG (Electrocardiogram)
- MRI (Magnetic Resonance Imaging)
The physician may suggest further tests depending on the health of the patient and their medical history. Do note that the patient may have to do all or a few of the above tests.
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Vertebral Disk Removal (Laminectomy) procedure?
- Why is this procedure necessary?
- What does the procedure involve?
- How will this procedure help?
- Will I be able to walk, sit, or rest properly after the procedure?
- Will I need any prosthetic after the procedure?
- How soon should I get it done? Is there an emergency?
- Who are the medical personnel involved in this procedure?
- How many procedure have you (the physician) performed?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place while recovering?
- When can I resume normal work?
- Are there any lifestyle restrictions or modifications required, after the procedure is performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- Is there any medication that needs to be taken for life, after the procedure?
- What are the costs involved?
During the Vertebral Disk Removal of Spine surgical procedure:
What kind of Anesthesia is given, during the Procedure?
During the procedure the patient is administered general anesthesia.
How much Blood will you lose, during the Procedure?
The Vertebral Disk Removal (Laminectomy) procedure is an open surgery; hence, there is some amount of blood lost, which varies from patient to patient.
What are the possible Risks and Complications during the Vertebral Disk Removal of Spine surgical procedure?
The possible risks or complications that may arise during the surgery are:
- Excessive bleeding
- Accidental injury to the nerves or spinal cord
- Spinal fluid leakage
- Incomplete disk removal
- Heart attack
- Breathing problems
What Post-Operative Care is needed at the Healthcare Facility after the Vertebral Disk Removal of Spine surgical procedure?
The healthcare facility must have an intensive care unit (ICU) attached, for immediate post-operative care and recovery, if needed. Apart from this, no particular care is needed unless complications arise.
After the Vertebral Disk Removal of Spine surgical procedure:
What are the possible Risks and Complications after the Vertebral Disk Removal of Spine surgical procedure?
Post Disk Removal surgery, the following complications may arise:
- Infection in the surgical wound
- Blood clots in the lungs or legs
- Impaired bladder function (rarely)
- Severe pain or increase in pain
- Anesthetic complications
What is the Prognosis after the Surgery?
- The recovery from the procedure is ‘good’ to ‘excellent’, though the chances of a complete recovery decrease with age
- The procedure provides almost immediate relief in 90% of the cases
- However, the chances of future spinal-related problems remain high
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Pain around the surgical wound; pain in the legs, back, or buttocks
- Swelling and redness
- Bleeding or drainage
- Constipation or abdominal bloating
- Loss of sensation or numbness
- Loss of control over bladder or bowel
- Muscle ache
- Nausea or vomiting
- Signs of infection
- If any new symptom or discomfort is observed
What Post-Operative Care is needed at Home after the Vertebral Disk Removal of Spine surgical procedure?
At home, the following post-operative care is recommended, after Vertebral Disk Removal (Laminectomy) procedure:
- Complete the course of medication
- Avoid strenuous exercises
- Keep the incision site clean and dry
- Wash the incision site with mild soap while bathing
- Resume daily activity only after the patient feels better
- Use ice packs or warm compress to reduce swelling and pain, or as directed by the physician
- Use stool softeners to prevent constipation
- Avoid taking non-prescribed medications
- Avoid sex, until advised otherwise by your physician
- Avoid driving up to 6 weeks after surgery
- Keep your legs elevated while resting
How long does it normally take to fully recover, from the Procedure?
It takes about 4-5 weeks to completely recover from the procedure. Patients usually experience discomfort and pain even during the recovery phase.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed, as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- The slide(s) are prepared once the tissue is processed, and this 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 Vertebral Disk Removal of Spine 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:
- The hospital
- The neurosurgeon or orthopedic surgeon
- An anesthesiologist (if anesthesia was administered)
- A pathologist (if the tissue was sent for analysis)
The patient is advised to double check the type of billing before a Vertebral Disk Removal (Laminectomy) 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