Laminectomy/Fusion for Tumor/Lesion removal
Why is this surgery done?
Your surgeon has recommended the removal of a spine tumor. Lesions of the spine may occur in the neck region (cervical), mid-back region (thoracic) or low-back region (lumbar-sacral). There are many types of tumors. Tumors can be benign (non-cancerous) or malignant (cancerous). The lesion may involve the spinal cord, nerve roots and/or the vertebrae (bones of the spine).
Symptoms from a spine tumor may include pain, numbness, tingling, weakness and loss of function. Surgery involves partial or total removal of the spine tumor. The goal of surgery is to prevent further loss of function. Surgery may also help reduce pain. Surgery cannot cure malignant spine tumors, but removal may help preserve function. Surgery can cure benign tumors.
Many times, a fusion (screws and rods) is recommended to reconstruct or stabilize the spine. Surgical approach may be posterior (back), anterior (front), lateral (side) or a combination of these. If a lateral thoracic approach is recommended, a thoracic surgeon may assist with the procedure. If an anterior approach is recommended, a vascular surgeon may assist. Your surgeon will clarify the specific procedure recommended for your surgery.
The time required for surgery will vary depending upon the procedure recommended. The surgery may last anywhere from 3 – 8 hours.
How is a laminectomy done?
An incision is made over the site of the spine that the tumor involves. Dissection through the tissues and muscles that overlie the spine is done so that we can expose the vertebrae (bones of the spine). We then remove a portion of the vertebrae (lamina) to gain access to the tumor in the spinal canal. Sometimes we need to open the coverings of the nerves (dura) exposing the spinal cord and spinal fluid to gain access to the tumor.
Tumor removal is accomplished using great care to separate the nerves from the lesion without damaging the nerves. Usually we are able to remove all or most of the lesion, especially in the case of a benign tumor. However, at times we are not able to remove all of the tumor safely.
Once we are satisfied with the removal of the tumor, the wound is closed with stitches. Sometimes we are able to replace the portion of the vertebrae (lamina) that was removed with very small screws (laminoplasty). Other times, placement of larger screws and rods is necessary to reconstruct that segment of the spine and restore stability (fusion). When the covering of the nerves has been opened, the first step in closing the wound is closing that membrane (dura). This needs to be done in a watertight fashion so spinal fluid will not leak. Oftentimes, a drain tube will be placed in the operative site to remove any fluid that may accumulate once the wound is closed.
What are my risks? What are common complications?
One of the most-often-experienced problems after this surgical procedure is an inability to regain normal neurological function. If you have spinal cord damage resulting in weakness, numbness or tingling in your arms or legs, the primary purpose of surgery is to prevent further loss of function and damage to the spinal cord. There is no guarantee that your pain will be relieved following surgery. You may experience some improvement of your symptoms, but you may have permanent damage that surgery cannot correct.
As you and your surgeon discuss this procedure in the office, your condition and any risks for surgery complications will be assessed and fully explained to you.
While complications from surgery are uncommon, some can be serious and may include:
- Heart or lung problems from general anesthesia, which could be fatal
- Bleeding, which could require a transfusion
- Infection of the incision, which could require IV antibiotics and another operation
- After removal of cervical tumors, difficulty swallowing and hoarseness, which could be temporary or permanent
- Damage to the covering of the nerve (the dura), which causes a spinal fluid leak and could require a drainage procedure or another operation. Although rare, this damage could result in paralysis, pain and bowel and bladder dysfunction.
- Deep vein thrombosis (DVT)
If fusion is required, long-term complications may include nonunion (the vertebrae do not mend or fuse together as they should), as well as failure of the medical hardware, which may require another operation. Additionally, the medical devices inserted during surgery may become painful and require removal. The surgery could also accelerate normal aging changes in the vertebrae next to the fusion.
What do I need to know before surgery?
When you decide to have this surgery, you will receive a surgery date and tentative surgery time. Then, on the working day before your scheduled operation date (on Friday for a Monday surgery, for example), you will receive the exact time of your surgery. Your surgeon’s office will call you by 3 – 5 p.m. to give you this time and make you aware of the time you need to arrive at the hospital. Because confirmed surgery times are unavailable to us until the day before your scheduled surgery, we appreciate your patience and understanding.
Before your surgery, preoperative testing will need to be completed. To ensure medical clearance and testing such as blood work and EKG are completed, the surgical facility will contact you and will schedule an appointment.
This important checklist will help to ensure that you are prepared and ready for your surgery. Please read it and ask your surgeon if you have any questions.
- If you take any blood thinners—for example Coumadin, aspirin, Plavix, Xeralto, Eliquis or Ticlid—make sure your surgeon is aware of this medication as soon as possible. You will be given specific instructions regarding any need to discontinue or modify your current use of any blood-thinning medication. If necessary, your surgeon will get clearance from your cardiologist or other physician to ensure that this medication change is safe and appropriate for you, based on your heart history, including prior heart attack, stent placement or open-heart surgery.
- Stop taking aspirin-based products one week before surgery. Also, stop taking nonsteroidal anti-inflammatory drugs such as ibuprofen, Naprosyn, Naproxen, Advil and Motrin, at least one week before surgery.
- Please do not eat or drink anything after midnight the day of your surgery. This includes water, coffee, chewing gum and hard candies. You may brush your teeth with toothpaste the morning of surgery. The anesthesiologist may cancel the surgery if you have had anything to eat or drink after midnight on the day of surgery.
- Some daily medications may be taken the day of surgery with a sip of water. Medications that are appropriate to take on the morning of surgery will be discussed with you by the hospital staff or your surgeon’s staff.
Please review all of the information in your patient folder, including the map with directions regarding parking locations and outpatient registration in the hospital if it applies to you. This will help you arrive at the hospital for check-in at the designated time provided by your surgeon’s office.
Your family may stay with you in the preoperative room until your scheduled surgery time.
General discharge instructions
After your surgery, you will be in the recovery room for at least 1 – 2 hours. When you first wake up from the anesthesia, your throat may feel sore, and you will likely feel cold, thirsty and groggy. Intravenous (IV) lines will be connected to supply your body with fluids, and you will have a catheter to drain your bladder.
After time in the recovery room, you will be transferred to your hospital room. Your family can return to spend time with you.
You will stay in the hospital until you have met specific goals. If you have a more complicated medical history, you may require a longer hospitalization. If you have additional neurological difficulties, you may also need rehabilitation therapy or extended care in a specialized facility. When you leave the hospital, you may have a rolling walker to help with your balance.
After you return home and are fully mobile, you may remove the support hose worn on your legs.
Before you leave the hospital, you may be fitted for a brace to restrict your movement if a fusion was required. You may need to wear a brace for as long as three months.
What should I expect while recovering?
To protect your health and help you feel better as soon as possible after surgery, your surgeon suggests these important restrictions:
- No driving. Driving will be discussed at your next appointment.
- Do not lift anything heavier than 10 pounds until you see your surgeon at the follow-up appointment 4 – 6 weeks after your surgery.
- Do not do things that put strain on your neck or your back. Such activities include laundry, sweeping, vacuuming, shoveling and yard work. When you are moving, remember to use good body mechanics, such as lifting objects close to your body rather than out in front of you.
- Do not smoke. It is not healthy for your back or your body’s healing abilities.
- Please avoid nonsteroidal anti-inflammatory drugs such as Celebrex, Motrin, ibuprofen, Advil and Aleve. These medications may hinder the bone growth needed for the fusion to occurring after surgery.
You may have significant pain around the surgical incision for the first few days and weeks after your surgery. You may experience some persistent numbness and tingling after surgery because your spinal cord and nerve root require time to recover. You may also experience discomfort and stiffness after surgery. To help you manage your pain, when you leave the hospital you will be given a prescription for pain medication.
Pain from surgery will change as you heal, and this fluctuation is normal and to be expected. As your healing progresses, consider these pain management techniques to help you gain control of your pain level.
- After acute surgical pain has improved, you should gradually discontinue use of the prescribed pain medication, which is often a narcotic. Prolonged use of such prescription narcotics will reduce your body’s production of natural pain-fighting chemicals. When this medication is used for an extended period of time, you may develop a tolerance to it, resulting in the need for higher levels of pain medication.
- Once the pain begins to subside and you no longer need the prescription pain medication, Tylenol and Tylenol-based products are safe to use. However, if a fusion operation was performed, you should avoid nonsteroidal anti-inflammatory drugs such as Celebrex, Motrin, ibuprofen, Advil and Aleve. While each of these pain medications is important for a variety of pain control needs, they can prevent bone fusion. These medications can usually be resumed 3 – 6 months after surgery. Before using these medications, please obtain approval from your surgeon.
- Ice may be used for discomfort as needed.
You will leave the hospital with a dressing on your incision site. This dressing should remain in place for 2 – 3 days after you return home. Under the dressing will be Steri-Strips, which are small adhesive strips across the surgical incision. Leave these Steri-Strips on the incision and allow them to fall off naturally. This usually occurs within two weeks. If after two weeks the Steri-Strips have not fallen off, you should remove them.
After removing the dressing, and if no drainage is evident, your incision can be left open to the air. It is important for a family member to examine your incision each day for two weeks after surgery to monitor it for any changes as the healing process continues.
If staples or sutures were used to close your incision, they will need to be removed 10 – 14 days after your surgery. Please call your surgeon’s office at (317) 396-1300 to schedule an appointment for this removal.
You may shower any time after surgery, but pay attention to your body and do not shower if you are feeling lightheaded or tired. Simply pat your incision dry after your shower and leave the incision open to the air under your clothing.
Do not take tub baths or Jacuzzi baths and do not go swimming for the first three weeks after your surgery.
General anesthesia, inactivity after surgery and pain-relieving prescription narcotics may cause constipation after surgery. It may be helpful to take a stool softener and/or laxative after surgery. These medications, which include Colace, Miralax and Senokot, may be purchased over the counter at your local pharmacy.
Possible physical therapy exercises
After leaving the hospital, physical therapy may or may not be necessary. Your best therapy is walking, which increases blood flow to the spine and assists in the healing process. Try walking on a structured basis, beginning slowly at first and progressing on a regular basis as your pain begins to lessen.
Some patients with impaired function may need inpatient rehabilitation after leaving the hospital. The physical therapist and your surgeon will help determine the best level of care needed after discharge.
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