Last Updated on December 3, 2025 by Bilal Hasdemir
People who have laminectomy surgery often worry if the lamina will grow back. The lamina is a key part of the vertebrae. It helps support and protect the spinal canal.
Thinking about laminectomy can be scary. Patients often ask about its long-term effects on their spine. Laminoplasty is another surgery that doesn’t remove the lamina. But, traditional laminectomy makes people worry about the lamina growing back and how it affects laminectomy recovery.
It’s important to know about the lamina in vertebrae and what happens when it’s removed. This helps patients make better choices about their treatment. We’ll look at what affects lamina regrowth and what it means for those having lapendectomy back surgery.
Key Takeaways
- Laminectomy involves removing part or all of the lamina, a portion of the vertebral bone.
- The concern about lamina regrowth after laminectomy is a worry for patients.
- Laminoplasty is an alternative surgical technique that preserves the lamina.
- Understanding the implications of laminectomy on spinal health is key.
- Factors influencing lamina regrowth include the extent of lamina removal and individual patient factors.
Understanding the Spinal Lamina and Its Function
The spinal lamina is key to protecting the spinal cord and keeping the spine stable. To grasp its importance, we need to know its anatomy and role in the spinal column.
Anatomy of the Vertebral Lamina
The vertebral lamina is the back wall of the vertebral arch. It forms a protective roof over the spinal canal. It’s a broad, flat bone plate that, with the pedicles, encloses the back of the vertebral foramen. The laminae of nearby vertebrae overlap, covering the spinal cord.
Role of Lamina in Spinal Protection and Stability
The lamina has two main roles in spinal protection and stability:
- Protection: It acts as a shield for the spinal cord, protecting it from injuries and compressions.
- Stability: It provides attachment points for muscles and ligaments, helping the spine stay stable and move freely.
Some key functions of the lamina include:
- Protecting the spinal cord from posterior injuries
- Serving as an attachment site for various muscles and ligaments
- Contributing to the posterior wall of the spinal canal
- Playing a role in the overall structural integrity of the vertebrae
In summary, the spinal lamina is a vital part of the vertebral arch. It’s essential for protecting the spinal cord and keeping the spine stable. Knowing its anatomy and function helps us understand spinal health and the effects of surgeries like laminectomy.
What is a Laminectomy?
A laminectomy is a back surgery that removes part of the vertebrae. This is called the lamina. It creates more space in the spinal canal. This surgery helps relieve pressure on the spinal cord or nerves.
Definition and Purpose
The main purpose of a laminectomy is to ease symptoms like pain, numbness, or weakness. These symptoms often occur in the arms or legs. By removing part of the lamina, surgeons can help nerves by improving mobility and reducing pain.
Conditions Requiring Laminectomy
Several spinal conditions may need a laminectomy. These include:
- Spinal stenosis: Narrowing of the spinal canal that can put pressure on the nerves.
- Herniated discs: When the soft inner gel of the disc leaks out and compresses nearby nerves.
- Tumors: Abnormal growths that can occur within the spinal canal.
- Degenerative disc disease: Wear and tear on the spinal discs that can lead to nerve compression.
Types of Laminectomy Procedures
There are various ways to perform a laminectomy, depending on the patient’s needs:
- Traditional Laminectomy: The classic open surgery method, involving a larger incision.
- Minimally Invasive Laminectomy: A more modern technique using smaller incisions and specialized instruments.
- Hemilaminectomy: Involves removing only one side of the lamina.
- Partial Laminectomy: Removing only the portion of the lamina that is compressing the nerves.
Each type of laminectomy has its own benefits and indications. The choice of procedure depends on the individual case and the surgeon’s professional judgment.
The Direct Answer: Does Lamina Grow Back After Surgery?
After a laminectomy, many wonder if their lamina will grow back. The lamina is key for spine protection and support. Knowing if it can regrow is important for recovery and expectations.
Scientific Evidence on Bone Regeneration
Research shows that lamina regrowth after laminectomy is rare. The lamina is a complex bone that protects the spine. Removing it during surgery is often needed to relieve pressure.
While bones can heal, the lamina’s unique shape and function make full regrowth hard. Studies suggest some bone repair happens naturally. But, it’s not a full regrowth of the lamina.
Factors Affecting Lamina Regrowth
Several things can affect lamina regrowth after laminectomy:
- Age and Overall Health: Younger, healthier people might heal better.
- Surgical Technique: The surgery method can influence healing. Less invasive methods might help more.
- Post-Operative Care: Following rehabilitation can aid in healing.
Long-term Spinal Stability Without Lamina
Removing the lamina doesn’t mean the spine will always be unstable. Surgeons use many ways to keep the spine stable:
- Spinal Fusion: Fusion can help stabilize the spine.
- Instrumentation: Devices like rods and screws keep the spine aligned.
- Rehabilitation: Physical therapy strengthens muscles, adding support.
In summary, while lamina regrowth is rare, the body can find ways to keep the spine stable. Knowing this helps patients set realistic goals and improve their recovery.
Lapendectomy Back Surgery: Procedure and Techniques
The field of laminectomy surgery is evolving fast. New surgical methods and technologies are being developed. These advancements help doctors tailor treatments to fit each patient’s needs, leading to better results and faster healing.
Modern Surgical Approaches
Today’s laminectomy surgeries are more advanced. They use the latest technology and methods. Minimally invasive techniques are leading the way, causing less damage and quicker healing.
Doctors are now making surgical plans that fit each patient’s unique situation. This personalized approach aims to improve results and reduce risks.
Minimally Invasive Options
Minimally invasive laminectomy is becoming a top choice for many. It uses smaller cuts, less muscle damage, and less harm to nearby tissues. This means patients often feel less pain and heal faster.
This method also leads to shorter hospital stays, lower infection risks, and less scarring. But, it’s not right for every case and depends on the surgeon’s skills.
Comparing Traditional and Advanced Techniques
Traditional open laminectomy and modern minimally invasive methods differ a lot. Traditional surgery uses bigger cuts and more tissue damage. This can cause longer healing times and more complications.
On the other hand, advanced techniques are less invasive, leading to better results. But, the choice between old and new methods depends on many factors. These include the patient’s health, the surgeon’s experience, and the specific needs of the surgery.
It’s important for patients to understand these differences. Talking to their surgeon about the pros and cons of each method helps them make the best choice for their situation.
Laminectomy Procedure Steps: What to Expect
Knowing what happens during a laminectomy can make you feel less anxious. We’ll walk you through everything, from getting ready to taking care of yourself after surgery. This will help you know what to expect.
Pre-Surgical Preparation
Before your laminectomy, several steps are taken to get you ready. These include:
- Diagnostic tests like MRI or CT scans to confirm the need for surgery
- Learning about the procedure, its risks, and benefits
- Getting instructions on what to eat and how to manage your medications
- Planning for care and support at home after surgery
During the Surgery
The laminectomy procedure involves removing part or all of the lamina. This is to relieve pressure on the spinal cord or nerves. Key steps during the surgery include:
- Getting anesthesia to stay comfortable during the procedure
- Making an incision in the back to reach the spine
- Removing the lamina or part of it to relieve pressure
- Closing the incision with sutures or staples
Immediate Post-Operative Care
After surgery, you’ll be watched in the recovery room for a few hours. Immediate care includes:
- Managing pain with medication
- Watching for any signs of complications
- Getting instructions for care at home
- Starting to move early to prevent blood clots and aid healing
By knowing these steps, you can prepare better for the laminectomy procedure and recovery.
How Long Does a Laminectomy Take?
Knowing how long a laminectomy takes can ease patient worries. The time needed for a laminectomy surgery changes based on a few things. These include how complex the surgery is and which part of the spine is being worked on.
Average Duration for Different Spinal Regions
The time for a laminectomy can vary a lot depending on the area of the spine. For example, a lumbar laminectomy usually lasts from 1 to 3 hours. On the other hand, a cervical laminectomy might take a bit longer because of the cervical spine’s delicate nature.
Average surgery times are as follows:
- Lumbar laminectomy: 1-3 hours
- Cervical laminectomy: 2-4 hours
- Thoracic laminectomy: 2-3 hours
Factors That May Extend Surgery Time
Several things can affect how long a laminectomy takes. These include:
- The patient’s overall health and anatomy
- The complexity of the condition being treated
- The need for additional surgical procedures, such as fusion
- The surgeon’s experience and the surgical team’s efficiency
We know every patient is different. Our surgical team considers all these factors to ensure the best results.
Hospital Stay Duration
How long a patient stays in the hospital after a laminectomy varies. Most patients stay for 1 to 3 days. This lets our medical team watch over the patient, manage pain, and handle any immediate issues.
Things that can affect how long a patient stays in the hospital include their health, if any complications arise, and the type of laminectomy done. We aim to give our patients the best care during their stay. This helps them recover well at home.
Comprehensive Laminectomy Recovery Timeline
After a laminectomy, patients go through several phases of recovery. Each phase is important for a full recovery. Knowing these phases helps manage expectations and makes the recovery smoother.
First Week After Surgery
The first week is key for recovery. Patients should rest and avoid hard activities. Pain management is a big focus, with meds to help with pain. Watch for signs of problems like infection or too much swelling.
Weeks 2-4 Recovery Milestones
In weeks 2-4, patients see big improvements. Gradual mobilization and gentle exercises start. These help recovery and strengthen back muscles. Patients can slowly do more, including light daily tasks.
Recovery Stage | Typical Activities | Expected Progress |
First Week | Rest, light stretching | Manageable pain, initial healing |
Weeks 2-4 | Gentle exercises, gradual mobilization | Improved mobility, reduced pain |
Months 1-3 | Progressive strengthening exercises | Significant improvement, return to most activities |
Months 1-3 Healing Process
In the first three months, healing is substantial. Patients can slowly get back to normal, including work and exercise. Physical therapy is key, helping muscles around the spine and improving flexibility.
Long-Term Recovery Expectations
Recovery in the first few months is significant. But, the long-term process goes beyond that. Patients should keep up with maintenance exercises for spinal health. Full recovery and return to all activities can take several months, sometimes up to a year or more.
Understanding the laminectomy recovery timeline helps patients navigate their healing journey. It helps them regain their quality of life.
Pain Management After Laminectomy
Managing pain after a laminectomy is key to a good recovery. It’s important to use a mix of methods to keep patients comfortable. This helps them heal smoothly.
Medication Protocols
Medicine is a big part of pain control after surgery. Doctors often use a mix of drugs to help with pain. These might include:
- Opioids: For really bad pain, but they’re used carefully because of side effects and addiction risks.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These help with pain and swelling.
- Muscle Relaxants: They help with muscle spasms.
It’s important to take your medicine as told and tell your doctor about any side effects.
Non-Pharmaceutical Pain Relief Methods
There are also ways to manage pain without medicine:
- Physical Therapy: Gentle exercises to get you moving and stronger.
- Heat and Cold Therapy: Using heat or cold packs to ease pain and swelling.
- Relaxation Techniques: Like deep breathing, meditation, or yoga to help you relax and reduce stress.
These methods can work together with medicine to help with pain.
When to Be Concerned About Post-Operative Pain
Some pain is normal after a laminectomy. But, some signs need quick medical help:
- Severe or Increasing Pain: If your pain gets worse or isn’t helped by your medicine.
- Numbness or Tingling: If you suddenly feel numb or tingly in your limbs.
- Signs of Infection: Fever, redness, swelling, or discharge from the surgery area.
Returning to Normal Activities After Surgery
Knowing when to start normal activities again after laminectomy is key to a good recovery. We’ll guide you through this carefully. It’s important to start slowly and safely to get back to your daily life.
Daily Activities Timeline
Most people can start with light activities a few weeks after surgery. Start with simple things like reading, watching TV, or short walks. As you get better, you can do more.
Here’s a general guideline for daily activities:
Activity | Timeline |
Light household chores | 2-4 weeks |
Moderate activities (e.g., grocery shopping) | 4-6 weeks |
Strenuous activities (e.g., heavy lifting) | 6-12 weeks |
Work Return Guidelines
Going back to work after laminectomy depends on your job and health. Desk jobs might be okay in 2-4 weeks. But jobs that are hard on your body might take 6-12 weeks or more.
Talk to your doctor about your job to figure out when you can go back.
Exercise and Physical Activity Progression
Starting to exercise is important for getting better. Start with gentle stretches and slowly add more challenging activities. Here’s a possible plan:
- Gentle stretching (2-4 weeks)
- Low-impact aerobics (4-6 weeks)
- Strengthening exercises (6-12 weeks)
Driving and Travel Considerations
Driving and traveling after laminectomy need careful thought. Don’t drive for 2-4 weeks or until you can do emergency stops easily. When traveling, take breaks to stretch and move around, even on long trips.
Key considerations for driving and travel:
- Avoid heavy lifting or bending.
- Take regular breaks during long trips.
- Consider having someone accompany you on long journeys.
By following these tips and talking to your doctor, you can safely and successfully get back to your normal activities after laminectomy surgery.
Comparing Laminectomy Variations
It’s important to know the differences between various laminectomy procedures. This is key for those thinking about spinal surgery. Laminectomy helps relieve pressure on the spinal cord or nerves. But, it’s not the same for everyone.
Laminotomy vs. Laminectomy: Key Differences
Laminotomy and laminectomy are often mixed up, but they’re not the same. Laminotomy removes part of the lamina, while laminectomy removes the whole thing. This can change how well you recover.
Choosing between laminotomy and laminectomy depends on your condition and the doctor’s advice. Research shows laminotomy might be better for younger patients because it keeps the spine more stable.
Procedure | Description | Recovery Time |
Laminotomy | Partial removal of the lamina | Typically shorter |
Laminectomy | Complete removal of the lamina | Generally longer |
Hemilaminectomy Recovery and Outcomes
Hemilaminectomy removes half of the lamina. It’s a more gentle way to help patients with nerve problems. Recovery is often quick, and many feel a lot better soon after.
“Hemilaminectomy has emerged as a valuable technique in spinal surgery, balancing decompression with preserving spinal stability.” – A Neurosurgeon
Partial Laminectomy Benefits
Partial laminectomy is like laminotomy but removes only what’s needed. This can cause less damage to the spine. It might lead to fewer problems and a faster recovery.
Partial laminectomy has its perks. It can lower the risk of spinal problems, reduce pain, and shorten hospital stays. But, it’s not right for everyone and depends on the doctor’s skill.
Complications and Risks of Laminectomy
It’s important for patients to know about the possible complications of laminectomy. This knowledge helps them make informed decisions about their spinal health. While we aim for the best results, laminectomy, like any surgery, comes with risks.
Common Side Effects
Most people who have laminectomy face some side effects. These are usually short-term and can be managed. Side effects might include:
- Pain or discomfort at the surgical site
- Numbness or tingling sensations
- Muscle weakness
- Fatigue
These side effects can be treated with medicine and physical therapy. It’s key for patients to follow their surgeon’s advice. This helps in a smooth recovery.
Serious Complications
Though rare, serious complications can happen. These might include:
- Infection
- Bleeding or hematoma
- Nerve damage
- Instability of the spine
These serious issues need quick medical care. We keep a close eye on patients after surgery. This way, we can spot and treat any problems fast.
Risk Factors for Poor Outcomes
Some factors can raise the risk of complications or poor results after laminectomy. These include:
Risk Factor | Description |
Age | Older patients might face more risks due to weaker bones and other health issues. |
Pre-existing Conditions | Conditions like diabetes, heart disease, or obesity can slow healing and increase risks. |
Smoking | Smoking can hinder bone healing and raise the risk of infection and other issues. |
Lumbar Laminectomy Syndrome
Lumbar laminectomy syndrome, or failed back surgery syndrome, is chronic pain after laminectomy. It can stem from unresolved original conditions, scar tissue, or new spinal instability.
Dealing with lumbar laminectomy syndrome often needs a team effort. This includes pain management specialists, physical therapists, and sometimes more surgery. We tailor treatment plans to meet each patient’s needs.
Physical Therapy and Rehabilitation Protocols
Rehabilitation after laminectomy is key to getting back on track. It helps patients regain strength and move better. A good rehab program supports healing, prevents problems, and boosts results.
Every patient’s journey is different. Our rehab plans are made just for them. We aim to get function back, cut pain, and boost life quality.
Early Mobilization Techniques
Starting to move early is vital after laminectomy. Gentle exercises help keep blood flowing, prevent stiffness, and keep joints moving. Early steps include:
- Gentle stretching to boost flexibility
- Short walks to keep blood flowing and prevent clots
- Breathing exercises to help with breathing
These steps start early, often right after surgery. Our physical therapists guide patients safely through these exercises.
Strengthening Exercises for Spinal Support
As recovery advances, strengthening exercises become key. They help support the spine, improve posture, and boost stability. Examples include:
- Core exercises to strengthen the lower back
- Resistance band exercises to build muscle
- Low-impact cardio to improve heart health
Working with a skilled physical therapist is essential. They create a strengthening plan that fits the patient’s needs and abilities.
Long-term Maintenance Programs
Keeping up with rehab is important for long-term benefits and to avoid future spinal problems. Our long-term programs focus on:
- Keeping up with exercises to maintain strength and flexibility
- Learning good posture to reduce spinal strain
- Making lifestyle changes to support spinal health
By making these habits part of daily life, patients can enjoy lasting benefits and better spinal health.
When Additional Surgery May Be Needed
While laminectomy can offer a lot of relief, some people might need more surgery. This could be because their symptoms didn’t fully go away or because of complications after surgery.
Revision Laminectomy: Causes and Considerations
A revision laminectomy is a second surgery after the first one. It’s needed if the nerves are compressed again or if the first surgery didn’t fix the problem. Facing more surgery can be scary, but it’s important to fix these issues to keep the spine healthy.
Deciding on a revision laminectomy involves a lot of thought. Doctors will look at images and do tests to see if it’s needed. They’ll check for scar tissue, instability, or if the disc is herniating again.
Signs of Failed Back Surgery Syndrome
Failed Back Surgery Syndrome (FBSS) is when pain keeps coming back after spinal surgery. Not all cases need more surgery, but some signs might mean you do. These include:
- Persistent or getting worse pain
- New nerve problems
- Coming back symptoms like before surgery
Talking to your doctor is key to figuring out why you’re in pain and what to do next.
Fusion After Laminectomy
Spinal fusion might be suggested with or after laminectomy. It makes the spine stable by joining vertebrae together. This is done to fix instability or prevent more problems.
Doctors decide on fusion based on how much bone was removed, if the spine was unstable before, and the spine’s overall health. We look at each case carefully to see if fusion is needed for long-term stability.
Special Considerations for Different Spinal Regions
Different parts of the spine face unique challenges after a laminectomy. The spine is complex, with each area having its own special features. These features affect how well a surgery goes. We’ll look at what’s special about cervical, thoracic, and lumbar laminectomies.
Cervical Laminectomy Recovery
Cervical laminectomy is done in the neck. It’s tricky because of the sensitive structures there. After surgery, it’s key to watch for nerve problems and manage pain well. Patients need to rest, then slowly start moving and doing exercises to get stronger.
Thoracic Laminectomy Challenges
Thoracic laminectomy is in the mid-back. It’s hard because of the rib cage and the spinal cord’s sensitivity. Doctors have to be careful to avoid hurting the nerves. After surgery, they watch for breathing problems and manage pain carefully.
Lumbar Laminectomy Outcomes
Lumbar laminectomy is in the lower back. It’s a common surgery that often helps a lot. Many people feel better from sciatica and lower back pain. But, how well it works depends on the problem being treated, the patient’s health, and following the recovery plan.
Spinal Region | Common Indications | Recovery Challenges | Typical Outcomes |
Cervical | Neck pain, radiculopathy | Neurological complications, pain management | Generally good, with careful post-op care |
Thoracic | Mid-back pain, spinal cord compression | Respiratory issues, neurological risks | Favorable with precise surgical technique |
Lumbar | Lower back pain, sciatica | Pain management, mobility recovery | High success rate with proper rehabilitation |
Advances in Laminectomy and Spinal Surgery
Medical technology is changing how laminectomy surgeries are done. New methods and techniques are being found. This is making spinal surgery better for patients.
Artificial Lamina Replacements
Artificial lamina replacements are a big hope for research. They aim to replace the lamina’s protective function after it’s removed. These devices are made to look and work like the real thing, helping avoid long-term problems.
Key benefits include better spinal stability and fewer complications after surgery. Scientists are working on materials that are strong and safe for the body. This could prevent bad reactions.
Regenerative Medicine Approaches
Regenerative medicine is also showing great promise. It includes stem cell therapy and tissue engineering. These methods could help heal and grow spinal tissues faster, leading to quicker recovery times.
Regenerative medicine could change how we treat spinal problems. It aims to fix the underlying issues and let the body heal itself. As research grows, we might see new treatments that could replace or work with traditional surgery.
Future Directions in Spinal Surgery
Spinal surgery is set to get even better with new technologies. Robotics, artificial intelligence, and 3D printing will make surgeries more precise and faster. This could lead to better results for patients.
As we look ahead, spinal surgery will keep getting better. It will be driven by new tech and a better understanding of spinal health. Patients will have more options and better outcomes thanks to these advances.
Finding the Right Specialist for Your Procedure
Choosing the right surgeon for your laminectomy is key to success. It’s important to know what to look for in a specialist.
Qualifications to Look For
When choosing a spine surgeon, look for these qualifications:
- Board certification in orthopedic surgery or neurosurgery
- Specialized training in spinal surgery
- Significant experience in performing laminectomies
- Positive patient reviews and outcomes
- Participation in ongoing education and training in spinal surgery techniques
These qualifications ensure your surgeon has the right skills for your procedure.
Questions to Ask Your Surgeon
Before deciding, ask your surgeon these questions:
- What experience do you have with laminectomy procedures?
- Can you share any patient testimonials or reviews?
- What are the possible risks and complications of my procedure?
- How will you manage my pain during and after surgery?
- What is your approach to follow-up care and rehabilitation?
These questions help you understand your surgeon’s qualifications for laminectomy specialist.
Second Opinion Considerations
Getting a second opinion is wise before surgery. It lets you:
- Confirm the initial diagnosis and recommended treatment plan
- Explore alternative treatment options
- Get a different perspective on your condition and treatment
- Feel more confident in your decision to proceed with surgery
Don’t hesitate to seek a second opinion if unsure. It’s your right to be fully informed.
By carefully choosing a qualified specialist, you can greatly improve your laminectomy’s success.
Conclusion: Living Well After Laminectomy
Having a laminectomy is a big deal, but many people get back to normal life with the right care. It’s all about post-op care, physical therapy, and changing your lifestyle. This helps a lot.
Getting back to daily life, like work and exercise, is key. But you should do it with the help of doctors. Taking care of your spine is important to avoid problems and feel better overall.
Knowing about the surgery, recovery, and what might happen is key. Working with a good healthcare team and sticking to a rehab plan helps a lot. This way, you can live better after a laminectomy.
FAQ
Does the lamina grow back after a laminectomy?
No, the lamina does not grow back after a laminectomy. This surgery removes part of the vertebra. The bone does not regrow like it was before.
What is the purpose of a laminectomy?
A laminectomy is done to ease pressure on the spinal cord or nerves. This is often due to spinal stenosis, herniated discs, or tumors.
How long does a laminectomy surgery take?
The time for a laminectomy surgery varies. It depends on the case’s complexity and the spinal area. It usually takes 1 to 3 hours.
What is the recovery time for a laminectomy?
Recovery from a laminectomy takes weeks to months. Most people get back to normal in 6-12 weeks.
What are the possible complications of a laminectomy?
Complications can include infection, nerve damage, spine instability, and bleeding. These risks depend on your health and the surgery details.
How is pain managed after a laminectomy?
Pain management includes medication, physical therapy, and methods like heat or cold therapy. This helps manage pain after surgery.
When can I return to work after a laminectomy?
Returning to work depends on your job, the surgery’s extent, and your recovery pace. It usually takes 2-6 weeks for less demanding jobs.
What is the difference between a laminotomy and a laminectomy?
A laminotomy removes a small part of the lamina. A laminectomy removes a larger part or the whole lamina.
How do I choose the right surgeon for my laminectomy?
Choose a surgeon based on their qualifications, experience, and patient reviews. Ask important questions during your consultation.
What is lumbar laminectomy syndrome?
Lumbar laminectomy syndrome, or failed back surgery syndrome, is chronic pain after a laminectomy. It’s often due to scar tissue or instability.
Are there any long-term restrictions after a laminectomy?
Long-term, avoid heavy lifting, bending, or twisting. Regular exercise helps keep the spine stable and strong.
Can I undergo a laminectomy if I have had previous spinal surgery?
Whether you can have a laminectomy after previous surgery depends on several factors. These include the reason for the previous surgery, your spine’s current state, and your overall health.
References
National Center for Biotechnology Information. Evidence-Based Medical Insight. Retrieved from https://pubmed.ncbi.nlm.nih.gov/1447247/