Lumbar Laminectomy

Lumbar Laminectomy

Anesthesia type	General
Airway	ETT
Lines and access	PIV, +/0 A-line
Monitors	Standard, +/- A-line
Primary anesthetic considerations
Preoperative
Intraoperative	Intraoperative electrophysiological monitoring if at level of spinal cord, Prone positioning
Postoperative	Pain control
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Lunar laminectomy is a complete removal of lamina, which is use for to decompress the neural elements of the lumbar spine, usually via a posterior approach in the prone position.

Overview

Indications

Lumbar radiculopathy 2° degenerative disc disease from herniated disks, congenital stenosis, neoplasm, and, occasionally, trauma. Lumbar laminectomy is also used to gain access to the spinal canal for dealing with intradural tumors, arteriovenous malformations (AVMs), and other spinal cord lesions.

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Intraoperative management

Monitoring and access

Large bore IV access. Potential for large volume blood loss.

Induction and airway management

Standard induction

Avoid long acting paralytic if neurophysiological monitoring. Consider succinylcholine or remifentanil bolus (1.5mg/kg)

Positioning

Prone positioning

Maintenance and surgical considerations

1-2 hour for single level

+0.5-1hr per additional level

TIVA if neurophysiological monitoring (Propofol, Remi, phenylephrine to support BP)

BIS or Massimo to monitor depth of anesthesia if using TIVA

Avoid large volume resuscitation given prone positioning

Procedure variants

	Variant 1	Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications