Laminectomy Flashcards
What is a laminectomy and why is it performed?
A laminectomy is the complete removal of the vertebral lamina
in order to decompress the neural elements of the spinal cord.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 122.
What is the difference between a laminotomy, a
laminectomy and a decompressive laminectomy?
Lumbar laminotomy is the removal of a part of the lamina.
Laminectomy is complete removal of the lamina. Both can be
used to treat radiculopathy due to degenerative disc disease. A
decompressive laminectomy is used to treat compression of the
cauda equina due to degenerative disc disease, spinal stenosis,
neoplasm, trauma, or stenosis.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 122.
How can an anesthetist assist the surgeon in
evaluating for a dural tear following a laminectomy?
By performing a Val Salva maneuver (sustained inspiratory
pressure of 30-40 cm H2O) to test the integrity of the dura.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 122.
What structures are at risk for damage during a
lumbar laminectomy?
Because the surgery is performed via a posterior approach, the
retroperitoneal structures such as intestines, gastrointestinal
structures, and great vessels are at risk for damage. The dura
and spinal cord are also at risk for damage during this
procedure.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 122.
In what positions are lumbar microdiscectomies
typically performed? How is this related to the risk of
bleeding?
Lumbar microdiscectomy may be performed in the prone or
kneeling positions, being careful to allow the abdomen to hang
free to prevent venous congestion in the epidural veins which
increases bleeding.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 962-963.
What forms of anesthesia are acceptable for lumbar
microdiscectomy?
Spinal anesthesia or general anesthesia are both acceptable for
traditional lumbar microdiscectomy. Percutaneous
microdiscectomies (minimally-invasive) are typically performed
under sedation (MAC) with local anesthesia.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 962-963.
What is the most common complications from using
the Andrews frame for performing a lumbar
laminectomy?
The Andrews frame secures the patient in knee-chest position
with the abdomen hanging freely which reduces intra-abdominal
pressure and contributes to decreased blood loss. Because the
legs are below the level of the heart, venous return is
decreased and severe hypotension can result.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1009.
In what ways can the patient be positioned for a
posterior cervical laminectomy? What are the
anesthetic implications of positioning for this
procedure?
Although the sitting position is becoming more rare, it is still
performed by surgeons who prefer it over the prone position. A
decompressive laminectomy is performed via a posterior,
midline approach with the head secured either in pins or a
horseshoe headrest. Posterior procedures performed in the
sitting position place the patient at risk for air embolism. It is
prudent in these cases to monitor heart sounds with a
precordial Doppler and place a central venous line prior to
surgery in order to aspirate air should an embolism occur.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 111-112.
What are the potential complications of an anterior
cervical laminectomy and/or discectomy?
Complications from anterior cervical surgery include
esophageal perforation, venous air embolus, damage to the
recurrent laryngeal nerve from retractors, tension
pneumothorax, and airway obstruction from hematoma.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 112-113.
