Procedure
description
A posterior thoracic
laminectomy for tumor is an operation performed to remove
a mass and decompress either a nerve or the spinal cord within
the thoracic area. We focus here on the posterior
(from the back) approach. The patient is brought
to the operating room, and put to sleep. Then, once
asleep and on a ventilator (breathing apparatus), the patient
is carefully turned into the prone position (face down).
Care is taken to ensure that all "bony" areas are
well protected, to prevent pressure sores. The surgeon
will now incise the skin overlying the appropriate levels
of the spine, and push the muscle away from the
spine. Retractors hold the muscle aside, and the surgeon
then removes several levels of lamina (roof of the spinal
cord). The surgeon now has several options, depending
upon where the tumor is located. If the tumor is epidural
(surrounding the firm covering of the spinal cord), then tumor
removal may begin. If the tumor is intradural extramedullary
(inside the tough covering of the spinal cord, but outside
the spinal cord itself), then the dura (tough covering of
the spinal cord) must be opened. If the tumor is intradural
intramedullary (within the tough covering of the spinal cord,
and within the spinal cord itself), then the surgeon must
open the dura (tough covering of the cord) and open the spinal
cord itself. Using the microscope to enhance vision,
the surgeon will try to remove as much of the tumor as possible.
Depending upon the type and extent of the tumor, this may
or may not be possible. Often, spinal cord monitoring
may be used during the case. After tumor removal or
partial removal has been accomplished, the surgeon will
close the muscle layer, deep fascia (deep fibrous tissue)
and skin.
Procedure
Risks
Posterior thoracic
laminectomy for removal of spinal cord tumors may
have moderate risks. Risks can be broken down
into two categories, 1) those related to the operative site,
and 2) those related to the risks of anesthesia.
Risks
related to the operative site:
Surgical
Exposure: The patient is placed in the prone position
(face down). In this position, there can be pressure
sores, pressure injuries to nerves, and injury to the eyes
as a result of pressure to them. During surgical dissection,
injury to muscle surrounding the spine can occur.
Spinal Cord/Nerve
Root injuries: If there is any injury to the spinal
cord in the thoracic area, this could result in paralysis
of the lower extremities, as well as loss of bowel, bladder
and sexual function. There may be a spinal
fluid leak, which could occur after a tear of the covering
of the spinal cord or nerve roots. There
is a small chance of causing instability.
Risks of tumor
removal depend to some degree upon the type and location
of tumor.
- If
a tumor is epidural (surrounding the tough covering of
the spinal cord), the cord itself does not need to be
entered.
- If a tumor
is intradural extramedullary (within the covering of the
spinal cord but outside of the spinal cord itself), there
are some increased risks because the delicate spinal cord
must be exposed, and the risk of postoperative spinal
fluid leaks increases.
- If a tumor
is intradural intramedullary (within the covering of the
spinal cord and within the spinal cord itself), the risks
are highest. In order to gain access to the tumor
within the spinal cord, the cord must be opened.
The surgeon will attempt to open the cord in the least
dangerous area possible, but some normal tissue must be
passed through to get to the tumor. This will result
in some type of neurological deficit, although it may
be very small. For example, there might be numbness
over a portion of the chest, or there may be some difficulty
with the ability to sense position of the a portion of
one lower extremity. Or the deficit could be greater.
There is also
the possibility that only a portion of the tumor may be
removed. If the tumor is stuck down to the surrounding
spinal cord or nerves, the surgeon may elect to remove a
small portion, rather than suffer great risks of nerve or
spinal cord injury. And, if the surgeon has achieved
a "gross total removal" of the tumor (in which
all visible tumor has been removed), there still is the
possibility that there may be recurrence of tumor.
General
Risks: These include general difficulties,
such as bleeding, infection, stroke, paralysis, coma and
death. Incisions on the back generally heal well,
but the incision site could be tender, or may
heal in an unpleasant manner, with scarring. There
is also the possibility that the surgery may not relieve
the symptoms for which the procedure was performed.
The problem for which the surgery was performed may recur,
requiring additional surgery in the future. In addition,
although every attempt is made to protect all areas of the
body from pressure on nerves, skin and bones, injuries to
these areas can occur, particularly with prolonged cases.
Risks of Anesthesia:
Blood clots in the legs, heart attacks, reaction to the
anesthetic, reaction to blood transfusion, if given.
Post-operative
care:
There shall
be no bending, twisting, or heavy lifting for several weeks
after surgery. Physical therapy may or may not be
implicated. Your doctor will gradually ease your work
restrictions, depending on your progress.
Remember to
keep the wound dry and clean. Notify your surgeon
of any drainage or temperatures greater than 101 Fahrenheit.
The goal of
this surgery was to achieve diagnosis and remove as much
of the tumor as possible. The healing process may
be a long one, depending on whether nerve root or spinal
cord damage was involved. Some continuing back
pain is not unusual during the first few days and weeks
following surgery. The following is a list of suggestions
that should help speed your recovery and give you every
possible chance for the best results from your surgery.
- Immediately
upon discharge, contact our office and set up an appointment
for staple removal if one has not already been set up.
- Take it
easy until seen by the physician. This does not
mean bed rest, but athletic activities during this period
are definitely not recommended. Please give your
incision a chance to heal. Avoid bending.
- If your
surgeon has prescribed for you a brace or corset, make
sure to wear it when you are out of bed. It will
help to support your spine while your own bone is healing.
- Lift nothing
heavier than a half gallon of milk until seen by your
doctor.
- Avoid sitting
for periods of time longer than 45 minutes. It is
OK to sit in a lounge chair which is laid back, for as
long as you wish.
- No jogging
or running.
- After you
get home, you may begin walking up to one mile per day.
- You may
walk up or down steps as often as you like. Please
take them smoothly and slowly.
- No driving
until OK with your physician. Do not ride further
than 50 miles at a time. This applies during
the first month after surgery.
- You may
shower after you go home unless otherwise instructed.
Cover the incision with plastic wrap before the shower
and remove it afterward. Change dressing immediately.
Tub baths are not advisable. You may shower without
covering the incision one week after the staples are out.
Follow instructions concerning care of tapestrips, stitches
or staples. Your surgeon or his nurse clinician
will explain the techniques used in the closure of your
incision.
- Sexual activities
are permitted.
- If you notice
swelling, redness or opening of the incision, or if there
is any clear fluid draining from it, please contact your
surgeon immediately! If you develop a fever, stiff
neck or chills, contact the office immediately.
Take your temperature at 4:00 PM daily until the clips
are removed. Call in greater than 101 degrees Fahrenheit.
- If you have
any questions, call our office, and for after hours emergencies,
call the medical society.
- Take your
medications prescribed on discharge, as directed.
- It takes
6 - 18 months for a nerve to heal. During that time
you may experience numbness, tingling, fleeting pain,
or creepy/crawly sensations.
- If there
has been spinal cord damage due to long term spinal cord
compression, it may take 1-2 years for an improvement,
and often, improvement will be very limited, if it does
occur at all.
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