LAMINECTOMY AND MASTOIDECTOMY

• Laminectomy


  Removal of one or more of the bony laminae that cover the vertebrae
• Laminectomy


  • Typically done to relieve pressure on the cord and nerve roots
• Vertebrae

  • 33 vertebrae
  • 24 mobile vertebrae
  • 9 fused vertebrae

  
• Laminectomy procedure

  1. Examine symptoms and previous treatment history

  2. Order imaging test of the spine

  3. Inform medication use and stopping use of tobacco products

  4. Getting complete physical and medical tests done

  5. Open surgeries are rescheduled in the morning with an overnight fast
• Laminectomy preparation

  1. Antiembolitic hose may be applied to the legs

  2. Patient position depends on type of laminectomy

  3. General anesthesia is employed with endotracheal intubation

  4. Padding of bony prominences and areas prone to pressure

  5. Hair removal in designated area
• Skin preparation

  1. Cervical: Prep solution applied to pin insertion sites, hair may need to be shaved, cleansing from supra-auricular border to axillae and down to neck and shoulders

  2. Thoracic: Cleansing from base of skull to waist and down to neck, shoulders, and sides

  3. Lumbar: Cleansing from shoulders to coccyx and down to sides
• Draping


  Surgeon usually does the draping, folded towels around operative site, sheet with fenestration or sterile plastic adhesive drape, drapes for microscope and fluoroscopy unit
• Laminectomy procedure

  1. Patient lies on back, given general anesthesia and intubated, rolled onto stomach with chest and sides supported

  2. Skin incision down middle of back over appropriate vertebrae, length depends on number of laminectomies

  3. Back muscles split and moved to expose lamina of each vertebra

  4. X-ray taken to verify correct vertebra, spinous process removed, lamina removed with drill or bone-biting tools, ligamentum flavum removed
• Decompressing spinal cord

  Dura mater exposed, surgeon retracts protective sac to remove bone spurs and thickened ligament
• Decompressing spinal nerve

  Facet joints undercut (foraminotomy) to enlarge neural foramen, discectomy performed if herniated disc is causing compression
• Fusion (if necessary)


  Joining of two vertebrae with bone graft held together with hardware like plates, rods, hooks, pedicle screws, or cages
• Closure


  Muscle and skin incisions sewn together with sutures or staples
• Lumbar laminectomy involves a ~1 inch incision, drilling through the lamina just outside the facet joint, lifting the lamina to expose ligament below, and excising the ligament overlying the thecal sac
• Laminectomy for herniated intervertebral disc

  Midline vertical incision, wound deepened, self-retaining retractors placed, fascia incised, paraspinous muscles and periosteum reflected, sponges packed along vertebrae, larger retractor placed, small portions of laminae overlying herniated disc removed, ligamentum flavum incised, nerve roots cautiously retracted, herniated disc removed
• Surgical procedure for laminectomy

  1. Elf-retaining retractors placed

  2. Fascia incised

  3. Paraspinous muscles and periosteum reflected

  4. Sponges packed along vertebrae

  5. Larger retractor placed for exposure

  6. Portions of laminae, vertebral spines, and intervertebral facets removed

  7. Ligamentum flavum incised

  8. Moistened cottonoids placed to protect dura

  9. Nerve roots retracted to expose herniated disc

  10. Disc removed

  11. Wound irrigated and examined

  12. Hemostasis achieved

  13. Wound closed in layers
• Risks and complications of laminectomy

  • Heart attack
  • Thrombus
  • General anesthesia complications
  • Chest infection
  • Muscle weakness
  • Shortness of breath
  • Bleeding
  • Infection
  • Blood clots
  • Nerve injury
  • Spinal fluid leak
  • Little to no pain relief after surgery
  • Back pain returns in the future
  • Headache
  • Difficulty controlling bladder or bowel movements
  • Leg pain
• Perioperative nursing care for laminectomy

  1. Preoperative: Ease patient's fears, discuss recovery, explain pain management, demonstrate Logrolling method, assess baseline motor/sensation

  2. Intraoperative: Assist with positioning, monitor vital signs, administer medications

  3. Postoperative: Keep head flat/elevated, urge supine position, inspect dressing, monitor for urinary retention, monitor vital signs, intake/output, wound, motor/neurologic function, bowel sounds, respiratory status
• Mastoidectomy


  Surgical procedure to remove diseased mastoid air cells from the mastoid bone behind the ear
• Types of mastoidectomy

  • Simple mastoidectomy
  • Radical mastoidectomy
  • Modified radical mastoidectomy
  • Canal-wall-up mastoidectomy
  • Canal-wall-down mastoidectomy
• Purpose of mastoidectomy

  • Treat chronic ear infections, cholesteatoma, or remove abnormal growths at base of skull
  • Prevent complications of mastoiditis like meningitis, brain abscess, or blood clots
• Mastoidectomy procedure

  1. Review imaging CT temporal bone, discuss facial nerve monitoring, shave hair, inject local anesthesia, position patient supine, shoulder elevated with head 80 degrees rotated, prepare sterile field

  2. Make incision at post-auricular sulcus, open mastoid bone, remove infected air cells, close surgical site
• Risks and complications of mastoidectomy

  • Facial nerve paralysis
  • Sensorineural hearing loss
  • Dizziness or vertigo
  • Change in taste
  • Tinnitus
  • Fluid leakage
  • Recurring infection
• Perioperative nursing care for mastoidectomy

  1. Preoperative: Patient education, anesthesia (sleepy) preparation, preoperative instructions, informed consent (IC), patient comfort and support (relax)

  2. Intraoperative: Monitor vital signs, manage anesthesia, monitor for complications (vs, sleepy)

  3. Postoperative: Monitor vital signs, manage pain (ouchie), monitor for complications and infection (pus), wound care (what care), health education (teach), provide emotional support (emo sup)