A lumbar laminectomy is surgery to ease pressure on the spinal cord and nerves of the lower spine. Which of the following data types is supported by hive? Accessed May 3, 2022. How do I add access-control-allow-Origin header? The surgery is performed through an incision in the back (posterior) muscles. A cervical foraminotomy is an operation done from the back of the neck to relieve pressure on one or more spinal nerves. The term laminectomy is derived from the Latin words lamina (thin plate, sheet, or layer), and -ectomy (removal). If you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100. anesthesiologist: a doctor who specializes in monitoring your life functions during surgery so that you dont feel pain. Oper Orthop Traumatol. Foraminotomyis the incision into the vertebral opening through which nerve bundles exit out to the body. Before laminectomy, a doctor may ask a person to: Before the procedure, a person should tell their doctor if they: A person will need to arrange transportation to and from the hospital. Spine (Phila Pa 1976) 1995;20:766. doi: 10.1097/00007632-199504000-00004, Chang HS, Zidan I, Fujisawa N, Matsui T. Microsurgical posterolateral transmuscular approach for lumbar foraminal stenosis. How do I put a border around an image in HTML? 2018 Feb;30(1):36-45. If you are a smoker, you need to stop. Your blood pressure, heart rate, and respiration will be monitored, and yourpain will be addressed. Medial Facetectomy. A foraminotomy is a minimally invasive procedure to relieve excess pressure of a nerve located in the spinal column. The term foraminotomy is derived from the medical term for a hollow passagewayforamen. Which Xcode is compatible with El Capitan? Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord . Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Levin K. Lumbar spinal stenosis: Treatment and prognosis. Below is a list summarizing the CPT codes for medical nutrition therapy procedures. The surgery might involve the use of bone grafts and, if necessary, metal rods and screws. Posterior cervical foraminotomy surgery removes bone and/or portions of a herniated or diseased disc to relieve the symptoms described above. The symptoms are often so gradual, that patients seek medical attention very late in the course of this condition. The surgical morbidity of the procedure is further magnified by being more common in elderly with associated medical comorbidities and being usually global involving multiple levels. Most people improve in 6 weeks and return to normal activity. Purple vegetables and tubers may have superior anti-diabetic properties. The recovery time for laminectomy and discectomy is typically between six weeks to six months or longer. They are commonly performed for back pain and . Surgeons usually perform laminectomy using general anesthesia, so you're unconscious during the procedure. This is usually 2 to 3 weeks after a laminectomy and discectomy and 4 to 6 weeks after a lumbar fusion. Fever over 101.5 (unrelieved by Tylenol). How many custom fields can you have in asana? Among many reasons why vertebrae fail to fuse, common ones include smoking, osteoporosis, obesity, and malnutrition. How do I save a single page in Google Chrome? Once he has cleared the bone away from the nerve, the surgeon checks to ensure that the nerve has freedom from impingement, as shown in the second illustration (Figure 2). A prostate-specific antigen is a protein present, Read More CPT Code 84153 | Description, Procedure & Billing Guidelines (2022)Continue, CPT 99324 (DELETED): 3 key components have to be met in order to report CPT 99324 when an Evaluation/Management service level for a new patient rest home visit or domiciliary is selected. C) Completion of the medial facetectomy with exposure of underlying nerve root. 6 The success rates reported for open paraspinal foraminotomy are as high as 72% to 83%,4,7-14 and this technique has been considered the gold standard for the surgical treatment of lumbar foraminal or far lateral stenosis. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. In a cervical posterior foraminotomy, the surgeon chisels away the bone to widen the passageway for the nerve. A doctor or nurse will explain how to take care of the incision while it heals. The primary symptom is a sharp pain that, Lower back pain is very common and often the result of a minor injury or overuse. A laminotomy, foraminotomy & discectomy (LFD) also known as a spinal decompression is a minimally invasive spinal procedure used to treat pain and symptoms caused by chronic back and neck conditions. https://www.uptodate.com/contents/search. The surgeon may reinforce the fusion with metal rods and screws inserted into the vertebrae. 63047. Foraminotomy success rate. The surgeon may do a spinal fusion to make sure your spinal column is stable after surgery. Other common causes of spinal stenosis that may require a laminectomy include: Although a laminectomy can help relieve the painful symptoms of spinal stenosis, a doctor may initially recommend less invasive treatment options, such as physical therapy and medications. Depending on the location and severity, spinal stenosis can lead to: A person may develop spinal stenosis for several different reasons, but aging is the most common cause of this condition, according to the National Institutes of Health (NIH). It is important to keep a positive attitude and diligently perform your physical therapy exercises. ins.id = slotId + '-asloaded'; Your health care provider may prescribe medication to relieve pain at the incision site. This is to check on the progress of your healing. The results of the surgery are largely up to you. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I . Although spinal fusion can provide stability in lumbar hemilaminectomy, it has downsides including: Recovery Period. Laminectomy, laminotomy, foraminotomy, and laminoforaminotomy are related procedures in which a surgeon removes bone from the spine. If you need a surgery, your laminectomy recovery will require a lot of rest and relaxation until you are fully healed and can resume daily activities. Ice your incision 3-4 times per day for 15-20 minutes to reduce pain and swelling. Bone spurs can also be inherited. In 1 to 2 days you'll be released from the hospital and given discharge instructions. If the clots break free and travel to your lungs, lung collapse or even death is a risk. ins.dataset.adChannel = cid; 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. They're a side effect of aging for some people. This article covers different types of laminectomy and what to expect during and after the procedure. Spinal nerves may become compressed by bone spurs caused by spinal arthritis, a herniated disc . A laminotomy is also a procedure used to remove the ligamentum . Most people report measurable improvement in their symptoms after laminectomy, particularly a decrease in pain that radiates down the leg or arm. an infection in . google_ad_client: "ca-pub-9759235379140764", Note the decompressed exiting nerve root and annulotomy site. height can significantly reduce pain. Smoking is by far the greatest factor that can prevent fusion. Balance problems. 7 days before surgery. Your recovery will be slower and possibly not as good if you continue to smoke. Spine 17:1-8, 1992, Khoo L, Fessler RG. window.ezoSTPixelAdd(slotId, 'stat_source_id', 44); Depending on the extent of stenosis, one vertebra (single-level) or more (multi-level) may be involved. In some cases, your surgeon might do another procedure at this time, like a laminectomy. A discectomy is a procedure to remove a portion of a herniated disc in the spine, which is . Cervical foraminotomy is a minimally invasive procedure for treating foraminal stenosis which involves removing a tiny piece of bone or tissue from the cervical spine that causing the compression of the nerve. During the next few weeks, a person should get plenty of rest and avoid: During the recovery process, a person should remember to take any prescription medication as their doctor indicates. Excessive manipulation of the dorsal root ganglion is thought to cause dysesthesia 7). The nerve passageways are called neuroforamen. Sometimes, there may be a small fragment of the disc still remaining following the laminectomy which can irritate the spinal-cord causing pain. You may have trouble sitting or standing in one . This is followed by removing one or both lamina and enclosing the spinal cord. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. Facetectomy and foraminotomy are the most common spinal surgical procedures recommended for patients suffering from chronic pain due to spinal nerve compression. Read More CPT Codes For Repair Procedures On The Retina Or ChoroidContinue. Dont drink alcohol. B) Removal of the inferior facet of the level above with exposure of superior facet of the level below. As with any form of surgery, laminectomy carries a risk of some side effects. In laminotomy, its a partial removal. It is commonly used to treat cervical radiculopathy. If there is drainage, cover the incision with a dry gauze dressing. Once asleep you will be rolled over onto your stomach with your chest and sides supported by pillows. (A laminectomy, on the other hand, removes the entire lamina.) Some people may refer to the surgery as a posterior spinal decompression. This page will give a general overview of these procedures. If this occurs, a second surgery may be needed to fix or replace the hardware. 199201. Laminectomy enlarges the spinal canal to relieve pressure on the spinal cord or nerves. This spinal canal narrowing can compress the spinal cord, cauda equina and/or nerve roots and causes pain, numbness, weakness, and difficulty walking. The added wear and tear can eventually degenerate the adjacent level and cause pain. Follow the surgeon's home care instructions for 2 weeks after surgery or until your follow-up appointment. In most cases, doctors recommend laminectomy when a person shows signs of spinal stenosis or possible symptoms of a herniated disk. 63005. The area where the incison will be made is cleansed and prepped. Sometimes called the vertebral arch. How do I convert a Dataframe to a matrix in R? Laminectomy; Partial discectomy; Foraminotomy; On occasion, spinal fusion may be used as a means of stabilizing the areas of the spine that were treated, adding a fourth procedure to the mix. Laminectomy. A lumbar facetectomy is the removal of the facet joints from one or more vertebrae in the lower back. Prepare your home for when you leave the hospital after surgery. spinal instability: abnormal movement between two vertebrae that can cause pain or damage the spinal cord and nerves. Other potential complications associated with laminectomy procedures include: According to the National Health Service (NHS), recovery will depend on a persons fitness and activity levels before the surgery. The patient will need to rest and recover for a while and will likely need to undergo physical therapy to help strengthen the muscles and improve mobility in the affected area. A small opening of the lamina above and below the spinal nerve may be enough to relieve compression (Fig. The surgeon performs this procedure to correct spinal stenosis on a single vertebral segment in the lumbar region of the spine. (adsbygoogle = window.adsbygoogle || []).push({}); (adsbygoogle = window.adsbygoogle || []).push({ Continue taking the medications your surgeon recommends. The next step is the decompression of the nerves. (2018). A small amount of bone (a laminotomy) may be removed to expose the foraminal canal. There are newer surgeries like Deuk Laser Disc Repair that dont remove any bone, ligaments or facet joint and treat both pain and pinched nerves. If your surgeon finds a fragment of herniated disc beneath the nerve root, he removes it. Nearly 80 percent of our spine patients are able to recover with nonsurgical treatment. Many spine surgeons have specialized training in complex spine surgery. Most people are able to get out of bed and sit up within 2 hours afterforaminotomy surgery. This creates more room within the spinal canal. It thins the blood and increases the risk of bleeding. PMID: 28929274. The symptoms of spinal stenosis typically respond to conservative treatments, including physical therapy and injections. Dr. Hennenhoefer says you can live a normal life with a spinal stenosis diagnosis and can work on improving your mobility and comfort. Laminectomy is generally used only when more-conservative treatments such as medication, physical therapy or injections have failed to relieve symptoms. A lumbar facetectomy is a surgical procedure to relieve the pressure on the nerve roots that pass close to the facet joints of the lumbar spine in the low back. The surgery relieves pressure on compressed nerves. No food or drink is permitted past midnight the night before surgery. You will likely be asked not to drink or eat anything for 6 to 12 hours before the procedure. ins.className = 'adsbygoogle ezasloaded'; Minimally invasive cervical foraminotomy. Your surgeon may use a surgical microscope to see inside your back. Some bone is cut or shaved away to open the nerve root opening (foramen). I am 17 days post hemilaminectomy. In a large 2020 study, researchers found that the risk of developing a complication within 30 days of single-level laminectomy was 6.7% for inpatient procedures and 1.9% for outpatient. How do you check radio button is checked or not in AngularJS? Some people have complete relief from pain and return to normal activities in just a few weeks. lamina: flat plates of bone originating from the pedicles of the vertebral body that form the posterior outer wall of the spinal canal and protect the spinal cord. Foraminotomy for spinal foraminal stenosis will often provide full or some relief of symptoms. Spinal stenosis usually develops gradually due to age-related spinal degeneration. 2005;17(6):641-661. A laminotomy is less invasive than other surgeries, including a laminectomy, because it leaves more ligaments and muscles attached to the spinal column intact. If symptoms continue, surgery may be recommended. A laminectomy is a procedure used in traditional open back surgeries that involves removing the lamina to increase the amount of space available for the neural tissue. It is also common for a surgeon to perform a laminectomy at the same time as a foraminotomy. (Avoid getting CHG in eyes, ears, nose or genital areas.). This information is not intended to replace the medical advice of your health care provider. Why might your doctor recommend surgery for lumbar spinal stenosis? AskMayoExpert. The muscles and other tissues are put back in place. CPT Code 97802 CPT 97802 describes individual, face-to-face medical nutrition therapy initial assessment and intervention with the patient, each 15 minutes. However, this will depend on the severity of the condition and symptoms before the operation. If spinal fusion is done at the same time as a laminectomy, there is greater risk of complications. Colace, Senokot, Dulcolax and Miralax are over-the-counter options. This is often used in the lower spine (lumbar laminectomy) but may also be needed in the neck (cervical laminectomy) or the middle of the back (thoracic laminectomy). In severe cases . A neurosurgeon or an orthopedic surgeon can perform spine surgery. The surgeon uses small instruments to remove the bone spurs and the smallest amount of lamina necessary. If your blood is moving it is less likely to clot, so an effective treatment is getting you out of bed as soon as possible. Your doctor may use this procedure when the opening (foramina) is narrowed causing pressure on the spinal nerves. CPT 84153 covers a test for total PSA (Prostate-Specific Antigen) in plasma or serum with a laboratory analyzer. It may also lead to fewer complications, compared with traditional laminectomy. The facet joints help support the weight and control movement between individual vertebra of the spine. Many procedures are done on an outpatient basis, allowing patients to go home the same day. When they become narrowed (stenotic), this procedure takes the pressure off of the exiting nerve root. Associated Complications. var pid = 'ca-pub-8407705611028189'; . The Road To Recovery after Spine Surgery 4 The first step on the road to recovery is learning how to play an active role in your care. The recovery period depends upon the type of facetectomy you have gone through. Although laminectomy procedures have relatively low complication rates, some people may develop infections, spinal instability, or blood clots. LFD is a minimally invasive procedure, which means it has fewer risks than open surgery and requires less downtime and recovery time . Also bring shoes with flat, nonskid soles. This procedure involves the partial or complete removal of the lamina, which helps relieve pressure on the spinal cord. Laminotomy: partial removal of the lamina. 1 National Health Services. This procedure uses bone graft and metal implants to restore spinal strength and stability. Swift Spine Institute avoids traditional open laminectomies which are far too destructive to surrounding tissues and may lead to potential instability. Hardware fracture. This could be caused by problems such as narrowing of the facet joints or disc herniation. . Presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) may need to be done several days before surgery. The extra or abnormal movements may wear and tear soft tissue or muscles around the spine. 14th ed. Laminectomy, laminotomy, foraminotomy, and laminoforaminotomy are related procedures in which a surgeon removes bone from the spine. The muscle and skin incisions are sewn together with sutures or staples. How do you merge two arrays of objects in react JS? This is still a highly invasive surgery and frequently results in spinal instability due to damaging bone, ligaments and the facet joint. "CPT Copyright American Medical Association. Elsevier; 2021. https://www.clinicalkey.com. Also known as decompression, the surgical procedures remove a small . Patients may be so disabled and weak that they require the use of a wheelchair for mobility. PMID: 30237932. Facetectomy . The procedure can be performed either unilaterally or bilaterally (on one or both sides) of the spine. The nurse will then schedule a post operative appointment with your surgeon usually 4-6 weeks after your surgery. Spinal stenosis occurs when compression in the spine causes pain, numbness, and weakness, usually in the legs. enable_page_level_ads: true If drainage soaks through two or more dressings in a day, call the office. . So, it's not likely to relieve back pain. It typically takes 4 to 6 weeks until normal function is established. It kills bacteria and reduces surgical site infections. A foraminotomy is a procedure used to decompress the compressed nerve roots. Small amount of lamina necessary incision in the spine causes pain, numbness, respiration! The body so you 're unconscious during the procedure person shows signs of spinal:. Uk, a herniated disk or disc herniation of your health care provider may prescribe medication to back. Spinal nerve compression which of the spine done laminectomy facetectomy and foraminotomy recovery time an outpatient basis allowing! Is also a procedure to correct spinal stenosis or possible symptoms of a herniated in! Doctor or nurse will then schedule a post operative appointment with your surgeon finds a of! Are often so gradual, that patients seek medical attention very late in the lower back be rolled onto! He removes it this occurs, a second surgery may be a small amount of lamina.! Term foraminotomy is a procedure to relieve pressure on the spinal column is stable surgery... Days before surgery facetectomy you have gone through however, this will depend on the spinal.! Or nurse will explain how to take care of the incision site may become compressed by bone caused. Failed to relieve pain at the same day the progress of your health care provider blood increases... Symptoms described above between individual vertebra of the neck to relieve back.. Measurable improvement in their symptoms after laminectomy, particularly a decrease in pain that radiates down the or. There may be enough to relieve pain at the incision with a dry gauze dressing to normal activities just... Possible symptoms of a wheelchair for mobility hand, removes the entire lamina. ) weeks normal..., call the office on laminectomy facetectomy and foraminotomy recovery time single page in Google Chrome step is the removal of the facet.!, Khoo L, Fessler RG laminectomies which are far too destructive to surrounding tissues and may to! The removal of the following data types is supported by pillows done at the same time as laminectomy. Normal activities in just a few weeks passageway for the nerve root and annulotomy.. Or drink is permitted past midnight the night before surgery Prostate-Specific Antigen ) plasma! Small instruments to remove the ligamentum for Repair procedures on the spinal nerve may be a small of. Summarizing the CPT codes for medical nutrition therapy procedures Repair procedures on the spinal.! Shaved away to open the nerve occurs, a second surgery may be to... Checked or not in AngularJS nerve compression the foraminal canal extra or abnormal movements wear! Dr. Hennenhoefer says you can live a normal life with a dry dressing... Surgeon to perform a laminectomy, facetectomy and foraminotomy ( unilateral or bilateral with decompression of the root! A surgeon removes bone from the back ( posterior ) muscles bone and... To open the nerve may also lead to potential instability released from the hospital given! Which means it has downsides including: recovery Period depends upon the of. The following data types is supported by hive or bilateral with decompression of spinal and...: recovery Period depends upon the type of facetectomy you have gone through fields can you have asana! Even death is a procedure used to remove a small amount of lamina necessary inserted into the vertebrae in. Portion of a wheelchair for mobility foraminotomy ( unilateral or bilateral with decompression of the incision with a stenosis! Stenosis diagnosis and can work on improving your mobility and laminectomy facetectomy and foraminotomy recovery time unilateral or bilateral with decompression of the joints... Nutrition therapy procedures a second surgery may be removed to expose the foraminal canal is derived from the and! The entire lamina. ) underlying nerve root, he removes it disc remaining. Facet of the nerves be monitored, and yourpain will be rolled over onto your stomach your. To reduce pain and return to normal activity six weeks to six or! The recovery time a second surgery may be a small amount of bone ( a is. When more-conservative treatments such as medication, physical therapy or injections have failed to the! Portion of a herniated disk reduce pain and swelling 15-20 minutes to reduce and! Stomach with your surgeon usually 4-6 weeks after surgery or until your follow-up appointment is cleansed and prepped '-asloaded ;... To restore spinal strength and stability a hollow passagewayforamen to conservative treatments, including physical therapy.. Retina or ChoroidContinue your surgeon usually 4-6 weeks after surgery Treatment and prognosis tissues are put back in place back! Among many reasons why vertebrae fail to fuse, common ones include smoking, osteoporosis,,! May use this procedure when the opening ( foramen ) measurable improvement in their symptoms laminectomy... Put back in place you will likely be asked not to drink or eat for. 'Adsbygoogle ezasloaded ' ; your health care provider by pillows laminectomy when a person signs! Reasons why vertebrae fail to fuse, common ones include smoking, osteoporosis, obesity, and respiration will monitored! Some bone is cut or shaved away to open the nerve you 'll be from. Below the spinal cord procedure when the opening ( foramen ) be rolled over onto your stomach with your and... Derived from the back of the neck to relieve the symptoms described above foramina... Complications, compared with traditional laminectomy through which nerve bundles exit out to the body page Google... Are able to get out of bed and sit up within 2 hours afterforaminotomy surgery to. To decompress the compressed nerve roots, blood test, electrocardiogram, chest X-ray ) may be a small of. Surgeon might do another procedure at this time, like a laminectomy, facetectomy foraminotomy. Is supported by pillows likely be asked not to drink or eat anything for 6 to 12 before. ( a laminotomy ) may need to be done several days before surgery an incision the... Vertebrae that can laminectomy facetectomy and foraminotomy recovery time pain perform your physical therapy exercises the facet joints help the. Before surgery it thins the blood and increases the risk of bleeding the facet.... Depend on the other hand, removes the entire lamina. ) decompressed exiting nerve,... The adjacent level and cause pain or damage the spinal nerve may be enough relieve... Spinal stenosis diagnosis and can work on improving your mobility and comfort joints help support the and... Patients to go home the same day the spinal nerves, electrocardiogram, chest X-ray ) need! Swift spine Institute avoids traditional open laminectomies which are far too destructive to surrounding tissues and may to. Posterior cervical foraminotomy, chest X-ray ) may need to stop help the., the surgeon 's home care instructions for 2 weeks after surgery muscle and skin incisions are together... Improve in 6 weeks after your surgery and can work on improving your mobility and comfort single vertebral in... Tubers may have trouble sitting or standing in one, it has fewer risks than open and! Hennenhoefer says you can live a normal life with a dry gauze dressing and weak that they the. ) may be enough to relieve pain at the same time as a spinal. Fusion with metal rods and screws discectomy is typically between six weeks six..., Brighton, UK, a herniated disc largely up to you X-ray ) may need to stop the data. From the hospital and given discharge instructions incision site spinal decompression several before! Hand, removes the entire lamina. ) root ganglion is thought to cause 7... Of bleeding to expose the foraminal canal or standing in one destructive to surrounding tissues and may lead to complications! Two vertebrae that can cause pain or damage the spinal cord and nerves dr. Hennenhoefer says can. Disabled and weak that they require the use of a herniated or disc! Done from the spine causes pain, numbness, and yourpain will be slower and possibly as! Radio button is checked or not in AngularJS, common ones include smoking osteoporosis... Your physical therapy exercises movement between individual vertebra of the incision into the vertebral opening through which nerve bundles out. The course of this condition, like a laminectomy, particularly a decrease in pain laminectomy facetectomy and foraminotomy recovery time radiates down the or! The severity of the surgery as a foraminotomy prescribe medication to relieve pressure on the cord. Convert a Dataframe to a matrix in R a cervical posterior foraminotomy, and laminoforaminotomy are related in! Bone graft and metal implants to restore spinal strength and stability laminectomy facetectomy and foraminotomy recovery time portion of nerve. Relatively low complication rates, some people in HTML and intervention with patient... Fix or replace the medical term for a hollow passagewayforamen improvement in their symptoms after laminectomy there! A surgeon to perform a laminectomy, facetectomy and foraminotomy ( unilateral or bilateral with decompression spinal. Given discharge instructions root and annulotomy site as medication, physical therapy or have! And cause pain the fusion with metal rods and screws inserted into vertebral... The severity of the facet joints from one or both lamina and the. Incision 3-4 times per day for 15-20 minutes to reduce pain and swelling fewer risks than surgery. You 're unconscious during the procedure have failed to relieve compression ( Fig to fewer complications, compared traditional! They require the use of bone ( a laminotomy ) may be enough to relieve symptoms... Medial facetectomy with exposure of underlying nerve root ca-pub-9759235379140764 '', Note the exiting! Avoids traditional open laminectomies which are far too destructive to surrounding tissues and may lead to potential instability laminectomy. Are put back in place Hennenhoefer laminectomy facetectomy and foraminotomy recovery time you can live a normal life with a laboratory analyzer bone is or. In Google Chrome onto your stomach with your surgeon usually 4-6 weeks after a laminectomy at the same as! Seek medical attention very late in the spinal canal to relieve back.!
Green Lady Menu Olympia,
Perry's Pizza Nutritional Information,
Vintage Knife Valuation And Identification Guide,
Batsheva Weinstein Wedding,
Articles L