A laminotomy is a minimally invasive, outpatient surgical procedure performed to widen the spinal canal where it has been narrowed by a thickening of the lamina, the thin bony layer that covers and protects the spinal cord. The lamina may thicken due to traumatic injury or degeneration, compressing the spinal nerves and resulting in pain and disability. A hemilaminotomy is a procedure during which the neurosurgeon removes the lamina only on one side of the spinal canal, the side that requires decompression.
Reasons for a Hemilaminotomy
The goal of a hemilaminotomy is to create more space in the spinal canal in order to relieve pressure on nerve tissue and reduce pain. This surgical procedure is performed to treat several conditions, including:
- Spinal stenosis
- Herniated disc
- Pinched nerve
- Bone spur
- Osteoarthritis of the spine
- Enlarged facet joints
The hemilaminotomy procedure may also be performed to remove the ligamentum flavum, a ligament in the spinal canal that sometimes thickens enough to compress the spinal cord.
The Hemilaminotomy Procedure
A hemilaminotomy may performed at any part of the spinal column: cervical, thoracic, sacral, or lumbar. Because on a small portion of the lamina and ligaments on only one side of the spine are removed, the risk of postoperative spinal instability is decreased. This procedure is frequently performed endoscopically, creating a smaller incision, less scarring and a speedier recovery.
Complete tumor resection (surgical removal) is usually the most effective treatment for spinal tumors, which can form inside the spinal cord; in the membranes covering the spinal cord; or between the membranes and the bones of the spine. Tumors that originate in spinal tissue are called primary spinal tumors; what causes them is unknown. Whether benign or malignant, spinal tumors can upset the connection between the brain and the nerves, or inhibit the spinal cord's blood supply. Spinal tumors can cause symptoms on one or both sides of the body.
Spinal Tumor Resection Procedure
Spinal tumor resection is performed under general anesthesia. An incision is made to expose the spinal cord and nerves, the tumor is removed, the incision is closed with (usually) staples or nylon suture, and a specimen of the tumor is sent to a lab for analysis. If the tumor is malignant, resection may be followed by radiation therapy to ensure that the malignancy is completely eradicated. Resection of a benign tumor can relieve compression on the spinal cord, thereby preventing nerve damage.
Recovery from Spinal Tumor Resection
After spinal tumor resection, a hospital stay of a few days is usually required; any pain is usually managed with oral analgesics. Bedrest is recommended to speed healing. Depending upon whether the tumor caused significant neurological damage prior to its being removed, physical therapy or rehabilitation may be needed. Strenuous activity is prohibited until approved by the surgeon.
Kyphoplasty is a minimally-invasive procedure to relieve pain from vertebral compression fractures, affecting the bones from which the spinal column is comprised. This procedure is usually performed on patients whose vertebral fractures have occurred as a result of osteoporosis. For best results, kyphoplasty should be performed within two months of the fracture's occurrence.
The Kyphoplasty Procedure
Kyphoplasty is a minimally-invasive procedure to relieve pain from vertebral compression fractures, affecting the bones from which the spinal column is comprised. This procedure is usually performed on patients whose vertebral fractures have occurred as a result of osteoporosis or tumor metastasis.
Kyphoplasty is performed as an outpatient procedure under general anesthesia. You will be lying facedown for the duration of the procedure, which lasts around an hour. Once the general anesthesia has taken effect, the skin surrounding your spine will be sterilized and shaved, and a tiny cut will be made in the area. With X-ray assistance, an empty needle known as a trocar will be inserted into the spine until its tip is positioned properly within the fractured vertebra. A balloon is then inserted though the needle and inflated, restoring the bone to its original shape and creating a cavity. The balloon is then removed and orthopaedic cement is injected into the area, filling the cavity. Finally, the trocar is removed, pressure is applied to stop the bleeding, and a bandage is placed around the skin.
Many spinal surgeries involve the use of metal rods, screws, plates and other devices to hold bones in place while the treated area heals. These devices are highly effective in helping patients heal properly with significant reductions in their pain and other symptoms. While this hardware remains in place in some cases, many times it needs to eventually be removed.
Hardware removal is a surgical procedure to take out the devices placed during surgery when they are no longer needed, or are causing symptoms of their own. This procedure can often be performed using minimally invasive techniques to reduce trauma and shorten recovery times. Recovery from hardware removal takes several weeks.
At present there is some debate about whether to remove hardware that has been used in previous spinal surgeries. While clearly it is not a good idea to have unnecessary hardware remain inside a patient, removing the materials can cause complications, particularly since scar tissue will have grown around the surgical site. Recently, a new evaluative tool, known as electrodiagnostic functional assessment, has become available. This assessment method combines electromyography (EMG), functional capacity evaluation (FCE), and range of motion (ROM) measurement to provide important data so that an informed decision can be made about whether hardware removal is necessary in an individual case.