A posterior thoracic
laminectomy for arteriovenous malformation (avm) is an operation
performed to remove or decompress the spinal cord from a vascular
(related to blood vessels) lesion. We focus here
on the posterior (from the back) approach. The
patient is brought to the operating room, and put to sleep.
Then, once asleep and on a ventilator (breathing apparatus),
the patient is carefully turned into the prone position (face
down). Care is taken to ensure that all "bony"
areas are well protected, to prevent pressure sores.
The surgeon will now incise the skin overlying the appropriate
levels of the spine, and push the muscle away
from the spine. Retractors hold the muscle aside, and
the surgeon then removes several levels of lamina (roof of
the spinal cord). The surgeon will now, using microscopic
guidance, either close off a fistula (communicating arterial
vessel) or dissect and cut out a vascular malformation.
There are a number of complex varieties of avm's, and your
surgeon will go into more detain about the intricacies pertinent
to your condition. Often, spinal cord monitoring
may be used during the case. After avm removal or partial
removal has been accomplished, the surgeon will close
the muscle layer, deep fascia (deep fibrous tissue) and skin.
laminectomy for removal of spinal cord avm's may
have moderate risks. Risks can be broken down
into two categories, 1) those related to the operative site,
and 2) those related to the risks of anesthesia.
related to the operative site:
Exposure: The patient is placed in the prone position
(face down). In this position, there can be pressure
sores, pressure injuries to nerves, and injury to the eyes
as a result of pressure to them. During surgical dissection,
injury to muscle surrounding the spine can occur.
Root injuries: If there is any injury to the spinal
cord in the thoracic area, this could result in paralysis
of the lower extremities, as well as loss of bowel, bladder
and sexual function. There may be a spinal
fluid leak, which could occur after a tear of the covering
of the spinal cord or nerve roots. There
is a small chance of causing instability.
Risks of avm removal depend to some degree upon the type
and location of tumor.
an avm is epidural (surrounding the tough covering of
the spinal cord), the cord itself does not need to be
entered. There may be a fistula (communicating vessel)
supplying the avm, and once this is divided, the avm within
the cord may "deflate."
- If an avm
is intradural extramedullary (within the covering of the
spinal cord but outside of the spinal cord itself), there
are some increased risks because the delicate spinal cord
must be exposed, and the risk of postoperative spinal
fluid leaks increases.
- If an avm
is intradural intramedullary (within the covering of the
spinal cord and within the spinal cord itself), the risks
are highest. Depending upon the extent and depth
of the avm within the cord, surgical risks may be great,
with significant chances of postoperative neurological
There is also the possibility that only a portion of the
avm may be removed.
Risks: These include general difficulties,
such as bleeding, infection, stroke, paralysis, coma and
death. Incisions on the back generally heal well,
but the incision site could be tender, or may
heal in an unpleasant manner, with scarring. There
is also the possibility that the surgery may not relieve
the symptoms for which the procedure was performed.
The problem for which the surgery was performed may recur,
requiring additional surgery in the future. In addition,
although every attempt is made to protect all areas of the
body from pressure on nerves, skin and bones, injuries to
these areas can occur, particularly with prolonged cases.
Anesthesia: Blood clots in the legs, heart attacks,
reaction to the anesthetic, reaction to blood transfusion,
be no bending, twisting, or heavy lifting for several weeks
after surgery. Physical therapy may or may not be
implicated. Your doctor will gradually ease your work
restrictions, depending on your progress.
keep the wound dry and clean. Notify your surgeon
of any drainage or temperatures greater than 101 Fahrenheit.
The goal of
this surgery was to achieve diagnosis and remove as much
of the tumor as possible. The healing process may
be a long one, depending on whether nerve root or spinal
cord damage was involved. Some continuing back
pain is not unusual during the first few days and weeks
following surgery. The following is a list of suggestions
that should help speed your recovery and give you every
possible chance for the best results from your surgery.
upon discharge, contact our office and set up an appointment
for staple removal if one has not already been set up.
- Take it
easy until seen by the physician. This does not
mean bed rest, but athletic activities during this period
are definitely not recommended. Please give your
incision a chance to heal. Avoid bending.
- If your
surgeon has prescribed for you a brace or corset, make
sure to wear it when you are out of bed. It will
help to support your spine while your own bone is healing.
- Lift nothing
heavier than a half gallon of milk until seen by your
- Avoid sitting
for periods of time longer than 45 minutes. It is
OK to sit in a lounge chair which is laid back, for as
long as you wish.
- No jogging
- After you
get home, you may begin walking up to one mile per day.
- You may
walk up or down steps as often as you like. Please
take them smoothly and slowly.
- No driving
until OK with your physician. Do not ride further
than 50 miles at a time. This applies during
the first month after surgery.
- You may
shower after you go home unless otherwise instructed.
Cover the incision with plastic wrap before the shower
and remove it afterward. Change dressing immediately.
Tub baths are not advisable. You may shower without
covering the incision one week after the staples are out.
Follow instructions concerning care of tapestrips, stitches
or staples. Your surgeon or his nurse clinician
will explain the techniques used in the closure of your
- Sexual activities
- If you notice
swelling, redness or opening of the incision, or if there
is any clear fluid draining from it, please contact your
surgeon immediately! If you develop a fever, stiff
neck or chills, contact the office immediately.
Take your temperature at 4:00 PM daily until the clips
are removed. Call in greater than 101 degrees Fahrenheit.
- If you have
any questions, call our office, and for after hours emergencies,
call the medical society.
- Take your
medications prescribed on discharge, as directed.
- It takes
6 - 18 months for a nerve to heal. During that time
you may experience numbness, tingling, fleeting pain,
or creepy/crawly sensations.
- If there
has been spinal cord damage due to long term spinal cord
compression, it may take 1-2 years for an improvement,
and often, improvement will be very limited, if it does
occur at all.