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1. Preparation

WHAT IS A LAMINECTOMY?

A laminectomy is a surgical procedure where an incision is made to access the spinal cord through the backbone. This is done to prevent further degeneration and to help relieve back and leg pain caused by conditions such as a prolapsed or herniated disc and spinal stenosis.

• Prolapsed or herniated disc – This condition is the result of the interior soft portion of the disc bulging out (herniation) and pushing through a weak area in the outside of the disc. This pushes down on a spinal cord nerve causing pain and in some cases, inflammation.
• Spinal stenosis – Is a condition that is caused when pressure is put on both the spinal cord and nerves caused by a narrowing of the spinal canal. This causes pain and numbness.

With ageing, the spine ligaments can harden and become thicker causing enlargement of the joint bones creating bone spurs. This is referred to as spine degeneration.

A laminectomy does not always work to relieve the symptoms and pain but does prevent the condition from worsening.

WHY IS IT DONE?

The purpose of a laminectomy is to alleviate pressure put on the nerve in the spine. This is achieved by trimming the top of the vertebrae, widening the spinal canal and creating more nerve space.

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a Neuro-surgeon who can perform the procedure.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Royal Australian College of Surgeons via their website at www.surgeons.org.

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).

To access a list of Neuro-surgeons who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor.

WHAT SHOULD I ASK MY SPECIALIST?

• Make sure you fully understand the procedure that is planned; do not be afraid to ask.
• It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.
• Apart from what the procedure is about you should also ask about:
  • Preparation
  • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
• Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • Aspirin (or any related products),
  • Blood thinners (Warfarin, heparin.),
  • Arthritis medication,
  • Insulin.

Don't forget to mention any homeopathic or herbal remedies you are taking, as these can have side effects and interactions too.

WHERE IS IT DONE?

A laminectomy is done in a hospital.

HOW LONG IS THE PROCEDURE?

A laminectomy normally takes between 1-3 hours. You will stay in hospital for approximately 5 - 8 days.

WHO IS INVOLVED?

The procedure is carried out as an inpatient in a hospital. The people involved in the procedure are:

• The Neuro-surgeon, your Specialist doctor
• The Anaesthetist: they will administer the general anaesthetic, look after you whilst the procedure is being carried out and are responsible for your post-operative pain relief
• Nurses for the procedure and recovery
• Radiologist for any X-rays
• Pathologist for any blood tests

HOW DO I PREPARE FOR A LAMINECTOMY?

Your doctor may ask you to cease taking any anti-inflammatory medication like ibuprofen and aspirin a few days prior to surgery and if you are a smoker, you will be asked to either stop or cut down prior to the procedure.

You should fast for at least 6 hours prior to the surgery. Your hospital will advise you of your exact fasting times.

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

• Do not bring any valuables with you
• Leave all jewellery at home, a wedding band is acceptable
• Wear warm comfortable clothing
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
• Bring any relevant x-rays or scans
• Slippers or flat rubber soled shoes for walking in the hallways
• Loose fitting clothing for the trip home
• Personal grooming items such as hairbrush, comb, toothbrush, deodorant etc.
• Undergarments and a dressing gown
• Remove all nail polish and do not wear any make-up

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Spinal Stenosis admissions for the financial year 06/07 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 328 overnight admissions with an average length of stay of 7.4 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 40303 and 40306.
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. diagnostic procedures. Therefore, the total average

medical service charge ($5,073) differs from the sum of the individual average charges

as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all

Spinal Stenosis admissions. The percentages shown for each type of medical service are

much higher as they are calculated for those services only and not the entire admission,

which includes all medical services and the hospital services. In an admission you may

have one medical service with an out of pocket expense, which then excludes the whole

admission from being fully covered. Hence the significant difference in percentage for

individual types of medical services as compared to the total admission fully covered.

For your information, the average charges for claims paid for Discectomy admissions for the financial year 06/07 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 130 overnight admissions with an average length of stay of 4.1 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 40301.
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. diagnostic procedures. Therefore, the total average

medical service charge ($4,519) differs from the sum of the individual average charges

as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all

discectomies. The percentages shown for each type of medical service are much higher

as they are calculated for those services only and not the entire admission, which

includes all medical services and the hospital services. In an admission you may have

one medical service with an out of pocket expense, which then excludes the whole

admission from being fully covered. Hence the significant difference in percentage for

individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive at the hospital or day surgery, the admissions clerk will attend to the paperwork associated with your stay.

On admission to the hospital a nurse will orientate you to your surroundings, ask your medical history, confirm your medication and will ask about any known allergies. The consent for the operation is attended to by the surgeon.

An anaesthetist will visit you prior to your operation. He/she will discuss with you what type of anaesthetic will be used throughout the procedure. They will also discuss pain management options with you.

A General anaesthetic is normally used for a laminectomy so this means that you will be asleep during the procedure.

An intravenous line will be put into the back of your hand to replace fluids and administer drugs during the surgery.

WHAT CAN I EXPECT DURING A LAMINECTOMY?

You will be taken into theatre and placed either on your side or face down on the operating table.

Once the anaesthetic has taken affect, an incision will be made in your back. The length of the incision is dependent on how many spine levels are affected. Fat and muscle are pulled aside using a retractor and the lamina, the bony plate that covers the spinal cord, is removed to allow the nerve roots to be seen.

Directly over the nerve roots are the facet joints. These joints are located in the back portion of the spine and are made up of two bony surfaces with cartilage as well as fluid for lubrication between them and a capsule surrounding it. The facet joints may be trimmed to allow more room for the nerve roots. If there are any bone spurs, they will be removed at this time.

If you have a herniated disc, your surgeon will remove it, taking the pressure off of the nerve so that it may heal. Removal of the disc leaves a space that will eventually fill with connective tissue.

When the surgery has been completed, the incision will be sutured closed. Either absorbable sutures (ones that gradually dissolve) or skin sutures will be used. If skin sutures are used, they will have to be removed once the incision has healed.

3. Aftercare

WHAT HAPPENS AFTER A LAMINECTOMY?

You will be moved to the recovery room directly after surgery where nursing staff will monitor your vital signs such as blood pressure, pulse and temperature.

In some cases your ability to pass urine may be affected immediately after surgery so this will also be monitored. In some instances patients have a catheter inserted while they are under the anaesthetic to drain their urine. This catheter may stay in for several days after your operation. Once you are fully conscious and all is well, you will be moved to the ward.

The intravenous tube will remain in for a few days so that you may be given fluids and in some cases antibiotics to prevent any possibility of infection. The wound site will be checked on a regular basis to ensure that there isn’t any swelling, excessive redness or signs of infection. You will be given pain relief that will also help with muscle spasms that can be present following a laminectomy.

After a few days you will be encouraged to get out of bed, walk short distances, sit and stand for short periods of time. A physiotherapist will teach you how to move correctly so that you do not hurt your back by either twisting or hyper extending. You will have a limited range of movement after the operation and measures to improve and cope with this will be discussed with you by your physiotherapist.

You will be given discharge instructions that you should strictly follow once you are at home. These instructions may include the following:

• Get plenty of rest for the first couple of weeks
• Continue prescribed medication, especially antibiotics
• Avoid any activities that strain the spine
• Avoid lifting
• Avoid wearing shoes with high heels
• Continue the exercises you were shown in hospital
• Sleep on a firm mattress
• Avoid or minimise driving or long car journeys
• Contact your doctor if you see any signs of infection (redness or drainage)

1. Preparation

WHAT IS A LAMINECTOMY?

A laminectomy is a surgical procedure where an incision is made to access the spinal cord through the backbone. This is done to prevent further degeneration and to help relieve back and leg pain caused by conditions such as a prolapsed or herniated disc and spinal stenosis.

• Prolapsed or herniated disc – This condition is the result of the interior soft portion of the disc bulging out (herniation) and pushing through a weak area in the outside of the disc. This pushes down on a spinal cord nerve causing pain and in some cases, inflammation.
• Spinal stenosis – Is a condition that is caused when pressure is put on both the spinal cord and nerves caused by a narrowing of the spinal canal. This causes pain and numbness.

With ageing, the spine ligaments can harden and become thicker causing enlargement of the joint bones creating bone spurs. This is referred to as spine degeneration.

A laminectomy does not always work to relieve the symptoms and pain but does prevent the condition from worsening.

WHY IS IT DONE?

The purpose of a laminectomy is to alleviate pressure put on the nerve in the spine. This is achieved by trimming the top of the vertebrae, widening the spinal canal and creating more nerve space.

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a Neuro-surgeon who can perform the procedure.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Royal Australian College of Surgeons via their website at www.surgeons.org.

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).

To access a list of Neuro-surgeons who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor.

WHAT SHOULD I ASK MY SPECIALIST?

• Make sure you fully understand the procedure that is planned; do not be afraid to ask.
• It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.
• Apart from what the procedure is about you should also ask about:
  • Preparation
  • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
• Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • Aspirin (or any related products),
  • Blood thinners (Warfarin, heparin.),
  • Arthritis medication,
  • Insulin.

Don't forget to mention any homeopathic or herbal remedies you are taking, as these can have side effects and interactions too.

WHERE IS IT DONE?

A laminectomy is done in a hospital.

HOW LONG IS THE PROCEDURE?

A laminectomy normally takes between 1-3 hours. You will stay in hospital for approximately 5 - 8 days.

WHO IS INVOLVED?

The procedure is carried out as an inpatient in a hospital. The people involved in the procedure are:

• The Neuro-surgeon, your Specialist doctor
• The Anaesthetist: they will administer the general anaesthetic, look after you whilst the procedure is being carried out and are responsible for your post-operative pain relief
• Nurses for the procedure and recovery
• Radiologist for any x-rays
• Pathologist for any blood tests

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Spinal Stenosis admissions for the financial year 06/07 are provided below: