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LUMBAR LAMINECTOMY

A lumbar laminectomy is a surgical procedure primarily designed to relieve pressure on the spinal cord or spinal nerves, often due to a condition called spinal stenosis.

Spinal stenosis involves a narrowing of the spinal canal, which can cause nerve compression that results in pain, numbness, or weakness, most commonly in the legs. In the lumbar region, this may also cause low back pain and difficulties in walking.

In a lumbar laminectomy, the surgeon removes the lamina, which is part of the vertebra that forms the "roof" of the spinal canal. Removing the lamina enlarges the spinal canal and reduces the pressure on the spinal cord or nerves.

                                                                                                 

                                                       Anesthetic Implications for Lumbar Laminectomy

Anesthesia type: General anesthesia

Airway: ETT

Preoperative:

  • Induction and intubation are performed while the patient is on the stretcher

  • Additional lines should be placed before turning the patient over to the prone position

  • Foam cradle or Prone View will be used for patient's face

  • Flex connector (accordion) may be used as tubing extender for ETT

  • Check and document the status of the eyes, nose, and chin when prone

  • Keep the head and neck in the neutral position

  • Intraoperative spinal cord monitoring should be considered

  • Evoked-potential monitoring may be used

  • Consider TIVA if neurophysiological monitoring

  • Consider BIS or Massimo to monitor depth of anesthesia if using TIVA

  • Check with surgeon regarding use of muscle relaxants

  • The risk of postoperative visual loss is increased in patients undergoing prone spinal surgery

Intraoperative:

  • The surgeon might request Valsalva maneuver (sustained inspiration at 30–40 cm H2O) to test the integrity of the repair

  • Somatosensory evoked potentials: potentials measured over the sensory cortex from stimuli applied to the posterior tibial nerves. SSEPs are transmitted via the posterior column of the spinal cord, around the territory of the posterior spinal arteries supplied by the posterior third of the cord

  • Motor evoked potentials:  current stimuli are applied to the motor cortex and measured. MEPs are incompatible with profound muscle relaxation.

  • All anesthetic vapors reduce MEP amplitude in a dose-dependent manner

  • The spinal cord may be at risk if the amplitude of somatosensory evoked potentials (SSEPs) are reduced to <50% of baseline values

  • Avoid large volume resuscitation due to prone positioning

  • Position: Prone

  • Duration: 2-4 hours

  • EBL: 25-500 mL

Postoperative:

  • Pain management

Complications:

  • Bleeding

  • Infection

  • Dural tear

  • Cerebrospinal fluid leak

  • Nerve root damage

  • Injury to retroperitoneal structures

  • Postoperative visual loss 

  • Postoperative respiratory complications

  • Abdominal organ dysfunction

Sources:

Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.

 

Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

Robert WA Nowicki, FRCA, Anaesthesia for major spinal surgery, Continuing Education in Anaesthesia Critical Care & Pain, Volume 14, Issue 4, August 2014, Pages 147–152, https://doi.org/10.1093/bjaceaccp/mkt041

Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

 

Orthopaedic Surgical Videos

Posterior Lumbar Laminectomy and Fusion

Spine Institute of North America

Endoscopic Lumbar Laminotomy

SpineTreatmentCenter

Surgical Procedures - Lumbar Laminectomy & Discectomy

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