Ops – Center for Advanced Spine Care of Southern Arizona

Procedure

Patient Name
First Last
Birth date
Chief Complaint
- Axial back pain
- Axial neck pain
- Cervical radiculopathy
- Gait & balance problems
- Inability to stand up straight
- Inability to walk for extended distances
- Loss of fine motor control
- Low back pain
- Lumbar radiculopathy
- Sacroiliac joint pain
- Sciatica
- Spinal deformity
- Thoracic back pain
- Thoracic radiculopathy
Procedure
Surgery Laterality
Cervical Level Surgery
- C1
- C2
- C3
- C4
- C5
- C6
- C7
Thoracic Level Surgery
- T1
- T2
- T3
- T4
- T5
- T6
- T7
- T8
- T9
- T10
- T11
- T12
Lumbar Level Surgery
- L1
- L2
- L3
- L4
- L5
- S1
- S2
Procedure Location
Attending Physician
Assistant
Anesthesiologist
Anesthesia
Antibiotic
Ancef Dosage
- 1g
- 2g
- 3g
Clindamicin dosage
- 600mg
- 900mg
Vancomicin
- 1g
- 2g
Complications
Complications Free Text
Procedure
PROCEUDRES LOCAL ANETHESTHESIA IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L2/L3 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L1/L2 Medial Branch Block 4. L2/L3 Medial Branch Block 5. L1/L2 Facet Block 6. L2/L3 Facet Block PROCEDURES POSTERIOR DECOMPRESSION IN DETAIL: 1. Laminotomy L2 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L2/L3 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION IN DETAIL: 1. Partial resection of L2 vertebral body by removal of bone from the superior articular process of L1 through a separate lateral skin and facial incision 2. Partial resection of L3 vertebral body by removal of bone from the inferior articular process of L2 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L2/L3
Procedure
PROCEUDRES LOCAL ANETHESTHESIA FOR BILATERAL INCISIONS IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L2/L3 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L1 / L2 Medial Branch Block 4. L2/L3 Medial Branch Block 5. L1 / L2 Facet Block 6. L2/L3 Facet Block PROCEDURES POSTERIOR DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Laminotomy L2 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L2 / L3 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Partial resection of L3 vertebral body by removal of bone from the superior articular process of L3 through a separate lateral skin and facial incision 2. Partial resection of L2 vertebral body by removal of bone from the inferior articular process of L2 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L2 / L3 PROCEDURES POSTERIOR DECOMPRESSION LEFT SIDE IN DETAIL: 1. Laminotomy L2 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L2 / L3 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION LEFT SIDE IN DETAIL: 1. Partial resection of L3 vertebral body by removal of bone from the superior articular process of L3 through a separate lateral skin and facial incision 2. Partial resection of L2 vertebral body by removal of bone from the inferior articular process of L2 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L2 / L3
Procedure
PROCEUDRES LOCAL ANETHESTHESIA FOR SELECT SIDE SIDED INCISIONS IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L2 / L3, and L3 / L4 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L1 / L2 Medial Branch Block 4. L2 / L3 Medial Branch Block 5. L3 / L4 Medial Branch Block 6. L1 / L2 Facet Block 7. L2 / L3 Facet Block 8. L3 / L4 Facet Block PROCEDURES POSTERIOR DECOMPRESSION SELECT SIDE SIDE IN DETAIL: 1. Laminotomy L2 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L2 / L3 on the surgical side through separate skin and fascial incision, 2. Laminotomy L3 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L3 / L4 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION SELECT SIDE SIDE IN DETAIL: 1. Partial resection of L3 vertebral body by removal of bone from the superior articular process of L3 through a separate lateral skin and facial incision 2. Partial resection of L2 vertebral body by removal of bone from the inferior articular process of L2 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L2 / L3. 4. Partial resection of L4 vertebral body by removal of bone from the superior articular process of L4 through a separate lateral skin and facial incision 5. Partial resection of L3 vertebral body by removal of bone from the inferior articular process of L3 through a separate lateral skin and facial incision 6. Tranforaminal Microdiscectomy at L3 / L4
Procedure
PROCEUDRES LOCAL ANETHESTHESIA FOR BILATERAL INCISIONS IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L2 / L3, and L3 / L4 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L1 / L2 Medial Branch Block 4. L2 / L3 Medial Branch Block 5. L3 / L4 Medial Branch Block 6. L1 / L2 Facet Block 7. L2 / L3 Facet Block 8. L3 / L4 Facet Block PROCEDURES POSTERIOR DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Laminotomy L2 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L2 / L3 on the surgical side through separate skin and fascial incision, 2. Laminotomy L3 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L3 / L4 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Partial resection of L3 vertebral body by removal of bone from the superior articular process of L3 through a separate lateral skin and facial incision 2. Partial resection of L2 vertebral body by removal of bone from the inferior articular process of L2 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L2 / L3. 4. Partial resection of L4 vertebral body by removal of bone from the superior articular process of L4 through a separate lateral skin and facial incision 5. Partial resection of L3 vertebral body by removal of bone from the inferior articular process of L3 through a separate lateral skin and facial incision 6. Tranforaminal Microdiscectomy at L3 / L4 PROCEDURES POSTERIOR DECOMPRESSION LEFT SIDE IN DETAIL: 1. Laminotomy L2 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L2 / L3 on the surgical side through separate skin and fascial incision, 2. Laminotomy L3 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L3 / L4 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION LEFT SIDE IN DETAIL: 1. Partial resection of L3 vertebral body by removal of bone from the superior articular process of L3 through a separate lateral skin and facial incision 2. Partial resection of L2 vertebral body by removal of bone from the inferior articular process of L2 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L2 / L3. 4. Partial resection of L4 vertebral body by removal of bone from the superior articular process of L4 through a separate lateral skin and facial incision 5. Partial resection of L3 vertebral body by removal of bone from the inferior articular process of L3 through a separate lateral skin and facial incision 6. Tranforaminal Microdiscectomy at L3 / L4
Procedure
PROCEUDRES LOCAL ANETHESTHESIA IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L3/L4 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L2/L3 Medial Branch Block 4. L3/L4 Medial Branch Block 5. L2/L3 Facet Block 6. L3/L4 Facet Block PROCEDURES POSTERIOR DECOMPRESSION IN DETAIL: 1. Laminotomy LUMBAR X on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L3/L4 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION IN DETAIL: 1. Partial resection of L4 vertebral body by removal of bone from the superior articular process of L3 through a separate lateral skin and facial incision 2. Partial resection of L4 vertebral body by removal of bone from the inferior articular process of L4 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L3/L4
Procedure
PROCEUDRES LOCAL ANETHESTHESIA FOR BILATERAL INCISIONS IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L3 / L4 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L2 / L3 Medial Branch Block 4. L3 / L4 Medial Branch Block 5. L2 / L3 Facet Block 6. L3 / L4 Facet Block PROCEDURES POSTERIOR DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Laminotomy L3 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L3 / L4 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Partial resection of L4 vertebral body by removal of bone from the superior articular process of L4 through a separate lateral skin and facial incision 2. Partial resection of L3 vertebral body by removal of bone from the inferior articular process of L3 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L3 / L4 PROCEDURES POSTERIOR DECOMPRESSION LEFT SIDE IN DETAIL: 1. Laminotomy L3 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L3 / L4 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION LEFT SIDE IN DETAIL: 1. Partial resection of L4 vertebral body by removal of bone from the superior articular process of L4 through a separate lateral skin and facial incision 2. Partial resection of L3 vertebral body by removal of bone from the inferior articular process of L3 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L3 / L4
Procedure
PROCEUDRES LOCAL ANETHESTHESIA FOR SELECT SIDE SIDED INCISIONS IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L3 / L4, and L4 / L5 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L2 / L3 Medial Branch Block 4. L3 / L4 Medial Branch Block 5. L4 / L5 Medial Branch Block 6. L2 / L3 Facet Block 7. L3 / L4 Facet Block 8. L4 / L5 Facet Block PROCEDURES POSTERIOR DECOMPRESSION SELECT SIDE SIDE IN DETAIL: 1. Laminotomy L3 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L3 / L4 on the surgical side through separate skin and fascial incision, 2. Laminotomy L4 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L4 / L5 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION SELECT SIDE SIDE IN DETAIL: 1. Partial resection of L4 vertebral body by removal of bone from the superior articular process of L4 through a separate lateral skin and facial incision 2. Partial resection of L3 vertebral body by removal of bone from the inferior articular process of L3 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L3 / L4. 4. Partial resection of L5 vertebral body by removal of bone from the superior articular process of L5 through a separate lateral skin and facial incision 5. Partial resection of L4 vertebral body by removal of bone from the inferior articular process of L4 through a separate lateral skin and facial incision 6. Tranforaminal Microdiscectomy at L4 / L5
Procedure
PROCEUDRES LOCAL ANETHESTHESIA FOR BILATERAL INCISIONS IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L3 / L4, and L4 / L5 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L2 / L3 Medial Branch Block 4. L3 / L4 Medial Branch Block 5. L4 / L5 Medial Branch Block 6. L2 / L3 Facet Block 7. L3 / L4 Facet Block 8. L4 / L5 Facet Block PROCEDURES POSTERIOR DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Laminotomy L3 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L3 / L4 on the surgical side through separate skin and fascial incision, 2. Laminotomy L4 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L4 / L5 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Partial resection of L4 vertebral body by removal of bone from the superior articular process of L4 through a separate lateral skin and facial incision 2. Partial resection of L3 vertebral body by removal of bone from the inferior articular process of L3 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L3 / L4. 4. Partial resection of L5 vertebral body by removal of bone from the superior articular process of L5 through a separate lateral skin and facial incision 5. Partial resection of L4 vertebral body by removal of bone from the inferior articular process of L4 through a separate lateral skin and facial incision 6. Tranforaminal Microdiscectomy at L4 / L5 PROCEDURES POSTERIOR DECOMPRESSION LEFT SIDE IN DETAIL: 1. Laminotomy L3 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L3 / L4 on the surgical side through separate skin and fascial incision, 2. Laminotomy L4 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L4 / L5 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION LEFT SIDE IN DETAIL: 1. Partial resection of L4 vertebral body by removal of bone from the superior articular process of L4 through a separate lateral skin and facial incision 2. Partial resection of L3 vertebral body by removal of bone from the inferior articular process of L3 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L3 / L4. 4. Partial resection of L5 vertebral body by removal of bone from the superior articular process of L5 through a separate lateral skin and facial incision 5. Partial resection of L4 vertebral body by removal of bone from the inferior articular process of L4 through a separate lateral skin and facial incision 6. Tranforaminal Microdiscectomy at L4 / L5
Procedure
PROCEUDRES LOCAL ANETHESTHESIA IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L4/L5 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L3/L4 Medial Branch Block 4. L4/L5 Medial Branch Block 5. L3/L4 Facet Block 6. L4/L5 Facet Block PROCEDURES POSTERIOR DECOMPRESSION IN DETAIL: 1. Laminotomy LUMBAR X on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L4/L5 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION IN DETAIL: 1. Partial resection of L5 vertebral body by removal of bone from the superior articular process of L4 through a separate lateral skin and facial incision 2. Partial resection of L5 vertebral body by removal of bone from the inferior articular process of L5 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L4/L5
Procedure
PROCEUDRES LOCAL ANETHESTHESIA IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L4/5 neuroforamen, 2. Local skin anesthesia in a trajectory aiming for the L5/S1 neuroforamen, 3. Local anesthesia at the high spot of the iliac crest on the surgical side, 4. L3/4 Medial Branch Block 5. L4/5 Medial Branch Block 6. L5/S1 Medial Branch Block 7. L3/4 Facet Block 8. L4/5 Facet Block 9. L5/S1 Facet Block PROCEDURES POSTERIOR DECOMPRESSION IN DETAIL: 1. Laminotomy L4 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L4/5 on the surgical side through separate skin and fascial incision. 2. Laminotomy L5 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L5/S1 on the surgical side through separate skin and fascial incision. PROCEDURES TRANSFORAMINAL DECOMPRESSION IN DETAIL: 1. Partial resection of L5 vertebral body by removal of bone from the superior articular process of L5 through a separate lateral skin and facial incision 2. Partial resection of L4 vertebral body by removal of bone from the inferior articular process of L4 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L4/5 4. Partial resection of S1 vertebral body by removal of bone from the superior articular process o fS1 through a separate lateral skin and facial incision 5. Partial resection of L5 vertebral body by removal of bone from the inferior articular process of L5 through a separate lateral skin and facial incision 6. Tranforaminal Microdiscectomy at L5/S1.
Procedure
PROCEUDRES LOCAL ANETHESTHESIA FOR BILATERAL INCISIONS IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L5 / S1 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L4 / L5 / S1 Medial Branch Block 4. L5 / S1 Medial Branch Block 5. L4 / L5 / S1 Facet Block 6. L5 / S1 Facet Block PROCEDURES POSTERIOR DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Laminotomy L5 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L5 / S1 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Partial resection of S1 vertebral body by removal of bone from the superior articular process of S1 through a separate lateral skin and facial incision 2. Partial resection of L5 vertebral body by removal of bone from the inferior articular process of L5 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L5 / S1 PROCEDURES POSTERIOR DECOMPRESSION LEFT SIDE IN DETAIL: 1. Laminotomy L5 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L5 / S1 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION LEFT SIDE IN DETAIL: 1. Partial resection of S1 vertebral body by removal of bone from the superior articular process of S1 through a separate lateral skin and facial incision 2. Partial resection of L5 vertebral body by removal of bone from the inferior articular process of L5 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L5 / S1
Procedure
PROCEUDRES LOCAL ANETHESTHESIA FOR SELECT SIDE SIDED INCISIONS IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L4 / L5, and L5 / S1 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L3 / L4 Medial Branch Block 4. L4 / L5 Medial Branch Block 5. L5 / S1 Medial Branch Block 6. L3 / L4 Facet Block 7. L4 / L5 Facet Block 8. L5 / S1 Facet Block PROCEDURES POSTERIOR DECOMPRESSION SELECT SIDE SIDE IN DETAIL: 1. Laminotomy L4 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L4 / L5 on the surgical side through separate skin and fascial incision, 2. Laminotomy L5 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L5 / S1 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION SELECT SIDE SIDE IN DETAIL: 1. Partial resection of L5 vertebral body by removal of bone from the superior articular process of L5 through a separate lateral skin and facial incision 2. Partial resection of L4 vertebral body by removal of bone from the inferior articular process of L4 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L4 / L5. 4. Partial resection of S1 vertebral body by removal of bone from the superior articular process of S1 through a separate lateral skin and facial incision 5. Partial resection of L5 vertebral body by removal of bone from the inferior articular process of L5 through a separate lateral skin and facial incision 6. Tranforaminal Microdiscectomy at L5 / S1
Procedure
PROCEUDRES LOCAL ANETHESTHESIA FOR BILATERAL INCISIONS IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L4 / L5, and L5 / S1 neuroforamen, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L3 / L4 Medial Branch Block 4. L4 / L5 Medial Branch Block 5. L5 / S1 Medial Branch Block 6. L3 / L4 Facet Block 7. L4 / L5 Facet Block 8. L5 / S1 Facet Block PROCEDURES POSTERIOR DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Laminotomy L4 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L4 / L5 on the surgical side through separate skin and fascial incision, 2. Laminotomy L5 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L5 / S1 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION RIGHT SIDE IN DETAIL: 1. Partial resection of L5 vertebral body by removal of bone from the superior articular process of L5 through a separate lateral skin and facial incision 2. Partial resection of L4 vertebral body by removal of bone from the inferior articular process of L4 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L4 / L5. 4. Partial resection of S1 vertebral body by removal of bone from the superior articular process of S1 through a separate lateral skin and facial incision 5. Partial resection of L5 vertebral body by removal of bone from the inferior articular process of L5 through a separate lateral skin and facial incision 6. Tranforaminal Microdiscectomy at L5 / S1 PROCEDURES POSTERIOR DECOMPRESSION LEFT SIDE IN DETAIL: 1. Laminotomy L4 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L4 / L5 on the surgical side through separate skin and fascial incision, 2. Laminotomy L5 on the surgical side with removal of the inferior lamina to complete hemilaminotomy with removal of lamina, ligamentum flavum microdiscectomy through midline, paraspinal approach at L5 / S1 on the surgical side through separate skin and fascial incision PROCEDURES TRANSFORAMINAL DECOMPRESSION LEFT SIDE IN DETAIL: 1. Partial resection of L5 vertebral body by removal of bone from the superior articular process of L5 through a separate lateral skin and facial incision 2. Partial resection of L4 vertebral body by removal of bone from the inferior articular process of L4 through a separate lateral skin and facial incision 3. Tranforaminal Microdiscectomy at L4 / L5. 4. Partial resection of S1 vertebral body by removal of bone from the superior articular process of S1 through a separate lateral skin and facial incision 5. Partial resection of L5 vertebral body by removal of bone from the inferior articular process of L5 through a separate lateral skin and facial incision 6. Tranforaminal Microdiscectomy at L5 / S1
Procedure
PROCEUDRES LEFT-SIDED LOCAL ANESTHESIA AND RHIZOTOMY VIA OPEN SKIN INCISION IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L3/4, L4/5, and L5/S1 facet joint complex, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L3/4 Medial Branch and Facet Block 4. L4/5 Medial Branch and Facet Block 5. L5/S1 Medial Branch and Facet Block 6. Direct and continuous visualization of the L4/5 facet joint complex with rhizotomy of the L4/5 facet joint complex via neurectomy of the directly visualized medial and lateral branch with controlled neural dissection and ablation with continuous, non-pulsed radiofrequency application heating tissues to over 60 degrees Celsius for a minimum of 90 seconds per ablation site on this surgical side. 7. Direct and continuous visualization of the L5/S1 facet joint complex with rhizotomy of the L5/S1 facet joint complex via neurectomy of the directly visualized medial and lateral branch with controlled neural dissection and ablation with continuous, non-pulsed radiofrequency application heating tissues to over 60 degrees Celsius for a minimum of 90 seconds per ablation site on this surgical side. PROCEDURES LEFT LATERAL RECESS DECOMPRESSION VIA SEPARATE INCISION: 1. Laminotomy through separate left-sided skin and fascial incisions L4/5 with partial removal of the inferior lamina via laminotomy with additional removal of ligamentum flavum on the left side decompressing the traversing nerve root under the direct and continuous visualization. 2. Laminotomy through separate left-sided skin and fascial incisions L5/S1 with partial removal of the inferior lamina via laminotomy with additional removal of ligamentum flavum on the left side decompressing the traversing nerve root under the direct and continuous visualization. PROCEUDRES RIGHT-SIDED LOCAL ANESTHESIA AND RHIZOTOMY VIA OPEN SKIN INCISION IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L3/4, L4/5, and L5/S1 facet joint complex, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L3/4 Medial Branch and Facet Block 4. L4/5 Medial Branch and Facet Block 5. L5/S1 Medial Branch and Facet Block 6. Direct and continuous visualization of the L4/5 facet joint complex with rhizotomy of the L4/5 facet joint complex via neurectomy of the directly visualized medial and lateral branch with controlled neural dissection and ablation with continuous, non-pulsed radiofrequency application heating tissues to over 60 degrees Celsius for a minimum of 90 seconds per ablation site on this surgical side. 7. Direct and continuous visualization of the L5/S1 facet joint complex with rhizotomy of the L5/S1 facet joint complex via neurectomy of the directly visualized medial and lateral branch with controlled neural dissection and ablation with continuous, non-pulsed radiofrequency application heating tissues to over 60 degrees Celsius for a minimum of 90 seconds per ablation site on this surgical side. PROCEDURES RIGHT LATERAL RECESS DECOMPRESSION VIA SEPARATE INCISION: 1. Laminotomy through separate left-sided skin and fascial incisions L4/5 with partial removal of the inferior lamina via laminotomy with additional removal of ligamentum flavum on the left side decompressing the traversing nerve root under the direct and continuous visualization. 2. Laminotomy through separate left-sided skin and fascial incisions L5/S1 with partial removal of the inferior lamina via laminotomy with additional removal of ligamentum flavum on the left side decompressing the traversing nerve root under the direct and continuous visualization.
Procedure
PROCEUDRES LEFT-SIDED LOCAL ANESTHESIA AND RHIZOTOMY VIA OPEN SKIN INCISION IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L4/5, and L5/S1 facet joint complex, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L4/5 Medial Branch Block 4. L5/S1 Medial Branch Block 5. Direct and continuous visualization of the L5/S1 facet joint complex with rhizotomy of the L5/S1 facet joint complex via neurectomy of the directly visualized medial and lateral branch with controlled neural dissection and ablation with continuous, non-pulsed radiofrequency application heating tissues to over 60 degrees Celsius for a minimum of 90 seconds per ablation site on this surgical side. PROCEDURES LEFT LATERAL RECESS DECOMPRESSION VIA SEPARATE INCISION: 1. Laminotomy through separate left-sided skin and fascial incisions L5/S1 with partial removal of the inferior lamina via laminotomy with additional removal of ligamentum flavum on the left side decompressing the traversing nerve root under the direct and continuous visualization. PROCEDURES LEFT SI-JOINT ABLATION VIA SEPARATE INCISION: 1. Radiofrequency ablation of the left-sided SI-Joint with continuous, non-pulsed radiofrequency application heating tissues to over 60 degrees Celsius for a minimum of 90 seconds per ablation site on this surgical side under direct and continuous visualization through separate skin and fascial incision. PROCEUDRES RIGHT-SIDED LOCAL ANESTHESIA AND RHIZOTOMY VIA OPEN SKIN INCISION IN DETAIL: 1. Local skin anesthesia in a trajectory aiming for the L4/5, and L5/S1 facet joint complex, 2. Local anesthesia at the high spot of the iliac crest on the surgical side, 3. L4/5 Medial Branch Block 4. L5/S1 Medial Branch Block 5. Direct and continuous visualization of the L5/S1 facet joint complex with rhizotomy of the L5/S1 facet joint complex via neurectomy of the directly visualized medial and lateral branch with controlled neural dissection and ablation with continuous, non-pulsed radiofrequency application heating tissues to over 60 degrees Celsius for a minimum of 90 seconds per ablation site on this surgical side. PROCEDURES RIGHT LATERAL RECESS DECOMPRESSION VIA SEPARATE INCISION: 1. Laminotomy through separate right-sided skin and fascial incisions L5/S1 with partial removal of the inferior lamina via laminotomy with additional removal of ligamentum flavum on the right side decompressing the traversing nerve root under the direct and continuous visualization. PROCEDURES RIGHT SI-JOINT ABLATION VIA SEPARATE INCISION: 1. Radiofrequency ablation of the right-sided SI-Joint with continuous, non-pulsed radiofrequency application heating tissues to over 60 degrees Celsius for a minimum of 90 seconds per ablation site on this surgical side under direct and continuous visualization through separate skin and fascial incision.
Indications
The patient has failed non-operative multimodality treatments for the preoperative condition and therefore consented to the combined midline and transforaminal unilateral single level decompression procedure through two separate fascial incions: a mideline paraspinal incision for the laminotomy part of the procedure, and a lateral paraspinal incision for the foraminotomy part of the procedure. The patient tells me that there have been multiple acute onset of excruciating disabling pain of an otherwise chronic disease course over a longer period of time which in the case the patient has been going on for several months. The patient is in pain practically every day and has described the pain as aching, cramping, fearful, gnawing, heavy, hot or burning, sharp, shooting, at times sickening, splitting, stabbing, and often as punishing or cruel, throbbing, and most of the time as tiring and exhausting. The patient’s lumbar symptoms including numbness, tingling and weakness radiating down from the low back and into the buttocks and thigh and calf into the toes are easily triggered with any activity but particularly by prolonged standing, carrying a heavy, weight, prolonged forward flexion. The patient is only able to get slow partial relief of symptoms with rest by sitting or lying down. The patient describes a significant Limitation of Activities of Daily Living (ADLs) including bathing, dressing, grooming, oral care, toileting, transferring, walking, climbing stairs, eating, shopping, cooking, managing medications, using the phone, handwriting and typing, housework, doing laundry, driving, and managing finances. In addition, there are some concerning patient safety issues with the patient’s mobility and control of motor function, which produces a higher fall risk. The patient has had an extensive trail of non-operative measures including physical therapy, chiropractic care, manipulation, self-directed exercise programs, acupuncture, biofeedback, and activity modification, weight loss, and unsuccessful trail of medical management with pain medication including NSAIDs and narcotics. In addition, the patient has had contraindications to non-surgical management including intolerance to NSAIDs affecting the patient’s liver, kidney and heart function. Moreover, the patient had to make use of assistive devices. The patient suffers from lumbar radiculopathy with sensory deficits and pain and pain induced weakness. According to Evidence Based Consensus Treatment Guidelines for Multidisciplinary Spine Care recognized and published by a number of national organizations and health insurance carriers, and the 2016 InterQual Medical necessity criteria for surgical procedures the patient’s lumbar discectomy, foraminotomy, and/or laminotomy is medically necessary because the patient has unremitting lumbar radiculopathy and progressive weakness secondary to nerve root compression in setting of failed non-operative treatment including PT and NSAIDs for the required minimum time period of 6 weeks. The summary description of the patient’s physical examination shows decreased functioning in the context of the patient’s Activities of Daily Living due to disabling pain with decreased mobility, and decreased range of motion, deformity, crepitus and tenderness of the affected spinal motion segments. Therefore, surgically treatment of the patient’s condition is appropriate and medically necessary. I discussed the procedure in detail, expected outcomes and benefits which includes a reduction of the patient's symptoms rather than complete resolution. Potential risks of the surgery were discussed with the patient which include but are not limited to blood loss, nerve, and vessel damage, paralysis, paraplegia, death, infection, dural leakage, foot drop, upper and lower extremity weakness, change in bladder and bowel function, bowel perforation, dysethetic leg pain, development of blood clots causing pulmonary embolism, use of non-FDA approved devices, failure of pain relieve, need for more spinal surgery including spinal fusion surgery. The patient had a chance to ask questions, all of which were answered to the patient's satisfaction. Informed consent was obtained in the office.
Indications
The patient has failed non-operative multimodality treatments for the preoperative condition and therefore consented to the combined midline and transforaminal bilateral single level decompression procedure through two separate fascial incions on each side. Thus, a total of 4 separate skin and fascial incisions were made: on each side a mideline paraspinal incision for the laminotomy part of the procedure, and a lateral paraspinal incision for the foraminotomy part of the procedure. The patient tells me that there have been multiple acute onset of excruciating disabling pain of an otherwise chronic disease course over a longer period of time which in the case the patient has been going on for several months. The patient is in pain practically every day and has described the pain as aching, cramping, fearful, gnawing, heavy, hot or burning, sharp, shooting, at times sickening, splitting, stabbing, and often as punishing or cruel, throbbing, and most of the time as tiring and exhausting. The patient’s lumbar symptoms including numbness, tingling and weakness radiating down from the low back and into the buttocks and thigh and calf into the toes are easily triggered with any activity but particularly by prolonged standing, carrying a heavy, weight, prolonged forward flexion. The patient is only able to get slow partial relief of symptoms with rest by sitting or lying down. The patient describes a significant Limitation of Activities of Daily Living (ADLs) including bathing, dressing, grooming, oral care, toileting, transferring, walking, climbing stairs, eating, shopping, cooking, managing medications, using the phone, handwriting and typing, housework, doing laundry, driving, and managing finances. In addition, there are some concerning patient safety issues with the patient’s mobility and control of motor function, which produces a higher fall risk. The patient has had an extensive trail of non-operative measures including physical therapy, chiropractic care, manipulation, self-directed exercise programs, acupuncture, biofeedback, and activity modification, weight loss, and unsuccessful trail of medical management with pain medication including NSAIDs and narcotics. In addition, the patient has had contraindications to non-surgical management including intolerance to NSAIDs affecting the patient’s liver, kidney and heart function. Moreover, the patient had to make use of assistive devices. The patient suffers from lumbar radiculopathy with sensory deficits and pain and pain induced weakness. According to Evidence Based Consensus Treatment Guidelines for Multidisciplinary Spine Care recognized and published by a number of national organizations and health insurance carriers, and the 2016 InterQual Medical necessity criteria for surgical procedures the patient’s lumbar discectomy, foraminotomy, and/or laminotomy is medically necessary because the patient has unremitting lumbar radiculopathy and progressive weakness secondary to nerve root compression in setting of failed non-operative treatment including PT and NSAIDs for the required minimum time period of 6 weeks. The summary description of the patient’s physical examination shows decreased functioning in the context of the patient’s Activities of Daily Living due to disabling pain with decreased mobility, and decreased range of motion, deformity, crepitus and tenderness of the affected spinal motion segments. Therefore, surgically treatment of the patient’s condition is appropriate and medically necessary. I discussed the procedure in detail, expected outcomes and benefits which includes a reduction of the patient's symptoms rather than complete resolution. Potential risks of the surgery were discussed with the patient which include but are not limited to blood loss, nerve, and vessel damage, paralysis, paraplegia, death, infection, dural leakage, foot drop, upper and lower extremity weakness, change in bladder and bowel function, bowel perforation, dysethetic leg pain, development of blood clots causing pulmonary embolism, use of non-FDA approved devices, failure of pain relieve, need for more spinal surgery including spinal fusion surgery. The patient had a chance to ask questions, all of which were answered to the patient's satisfaction. Informed consent was obtained in the office.
Hidden
Indications
The patient has failed non-operative multimodality treatments for the preoperative condition and therefore consented to the combined midline and transforaminal bilateral multilevel decompression procedure through a minimum of two separate fascial incions on each side. Thus, a minimum of 4 separate skin and fascial incisions were made in total: on each side a mideline paraspinal incisions for the laminotomy part of the procedure, and a lateral paraspinal incisions for the foraminotomy part of the procedure. The patient tells me that there have been multiple acute onset of excruciating disabling pain of an otherwise chronic disease course over a longer period of time which in the case the patient has been going on for several months. The patient is in pain practically every day and has described the pain as aching, cramping, fearful, gnawing, heavy, hot or burning, sharp, shooting, at times sickening, splitting, stabbing, and often as punishing or cruel, throbbing, and most of the time as tiring and exhausting. The patient’s lumbar symptoms including numbness, tingling and weakness radiating down from the low back and into the buttocks and thigh and calf into the toes are easily triggered with any activity but particularly by prolonged standing, carrying a heavy, weight, prolonged forward flexion. The patient is only able to get slow partial relief of symptoms with rest by sitting or lying down. The patient describes a significant Limitation of Activities of Daily Living (ADLs) including bathing, dressing, grooming, oral care, toileting, transferring, walking, climbing stairs, eating, shopping, cooking, managing medications, using the phone, handwriting and typing, housework, doing laundry, driving, and managing finances. In addition, there are some concerning patient safety issues with the patient’s mobility and control of motor function, which produces a higher fall risk. The patient has had an extensive trail of non-operative measures including physical therapy, chiropractic care, manipulation, self-directed exercise programs, acupuncture, biofeedback, and activity modification, weight loss, and unsuccessful trail of medical management with pain medication including NSAIDs and narcotics. In addition, the patient has had contraindications to non-surgical management including intolerance to NSAIDs affecting the patient’s liver, kidney and heart function. Moreover, the patient had to make use of assistive devices. The patient suffers from lumbar radiculopathy with sensory deficits and pain and pain induced weakness. According to Evidence Based Consensus Treatment Guidelines for Multidisciplinary Spine Care recognized and published by a number of national organizations and health insurance carriers, and the 2016 InterQual Medical necessity criteria for surgical procedures the patient’s lumbar discectomy, foraminotomy, and/or laminotomy is medically necessary because the patient has unremitting lumbar radiculopathy and progressive weakness secondary to nerve root compression in setting of failed non-operative treatment including PT and NSAIDs for the required minimum time period of 6 weeks. The summary description of the patient’s physical examination shows decreased functioning in the context of the patient’s Activities of Daily Living due to disabling pain with decreased mobility, and decreased range of motion, deformity, crepitus and tenderness of the affected spinal motion segments. Therefore, surgically treatment of the patient’s condition is appropriate and medically necessary. I discussed the procedure in detail, expected outcomes and benefits which includes a reduction of the patient's symptoms rather than complete resolution. Potential risks of the surgery were discussed with the patient which include but are not limited to blood loss, nerve, and vessel damage, paralysis, paraplegia, death, infection, dural leakage, foot drop, upper and lower extremity weakness, change in bladder and bowel function, bowel perforation, dysethetic leg pain, development of blood clots causing pulmonary embolism, use of non-FDA approved devices, failure of pain relieve, need for more spinal surgery including spinal fusion surgery. The patient had a chance to ask questions, all of which were answered to the patient's satisfaction. Informed consent was obtained in the office.
Narrative Description
The risks and benefits and alternative treatments have been thoroughly reviewed in clinic prior to today and the patient has reviewed the Center for Advanced Spinal Care patient education materials on this procedure. The patient has signed the informed consent for the direct posterior midline and paraspinal transforaminal decompression as outlined above. The patient was transported to the operating room, placed prone position on the Wilson frame, routine monitors were applied, and the back was prepped with CHG and Chloraprep, and draped in a standard sterile surgical fashion. The fluorscopy unit was sterilely draped and brought into the field for intraoperarive imaging and identification of surgical level. After local skin anesethesia was applied, small open incisions were made over the surgical level and the spine was accessed with the aid surgical tubular retractors, whose position was then radiographically verified intraoperatively. Facet and medial branch blocks were also performed during this portion of the case to achieve inra- and postoperative pain control. These procedures were also done at adjacent levels to address cross-innervation. On the right side the direct posterior decompression was done via a hemilaminotomy was performed and the lateral recess was decompressed surgically. An endoscope was also used during this portion of the case to aid in the continuous direct visualization of the the surgery. This resulted in partial removal of the lamina starting of the inferior margin and partial removal of the medial fect joint and removal of ligamentum flavum using rongeurs and drills. The intervertebral disc and the traversing nerve root were visualized. On the right side the transforaminal foraminotomy decompression was done via sequentially larger reamers were introduced into the neuroforamen with constant monitoring of the patients motor function in the lower extremity on the surgical side. The reaming allowed partial resection of the superior and inferior articular process at the surgical level. The decompression of the neural elements was further aided by removal of the hypertrophic superior and inferior articular process using power drills. a 3-0 Kerrison rongeur was also used during this portion of the procedure. A continuous radiofrequency probe was used to achieve hemostasis. An osteotome was used to perform a partial corpectomy with removal of a section of the posterior vertebral body to surgically release the traversing and exiting nerve roots that were entrapped under the facet complex due to significant hypertrophy of the facet joints as well as the ring apophysis of the superior and inferior vertebral bodies at the surgical level. In addition to a microdiscectomy, a partial pediculectomy was performed on the inferior pedicle of the surgical level to adequately decompress the traversing nerve root as well. The vertebral osteotomy, and partial facet resection produced a significant increase in the neuroforaminal volume. On the left side the direct posterior decompression was done via a hemilaminotomy was performed and the lateral recess was decompressed surgically in a similar manner under continuous direct visualization of the the surgery. This resulted in partial removal of the lamina starting of the inferior margin and partial removal of the medial fect joint and removal of ligamentum flavum using rongeurs and drills. The intervertebral disc and the traversing nerve root were visualized. On the left side the transforaminal foraminotomy decompression was done via sequentially larger reamers were introduced into the neuroforamen with constant monitoring of the patients motor function in the lower extremity on the surgical side. The reaming allowed partial resection of the superior and inferior articular process at the surgical level. The decompression of the neural elements was further aided by removal of the hypertrophic superior and inferior articular process using power drills. a 3-0 Kerrison rongeur was also used during this portion of the procedure. A continuous radiofrequency probe was used to achieve hemostasis. An osteotome was used to perform a partial corpectomy with removal of a section of the posterior vertebral body to surgically release the traversing and exiting nerve roots that were entrapped under the facet complex due to significant hypertrophy of the facet joints as well as the ring apophysis of the superior and inferior vertebral bodies at the surgical level. In addition to a microdiscectomy, a partial pediculectomy was performed on the inferior pedicle of the surgical level to adequately decompress the traversing nerve root as well. The vertebral osteotomy, and partial facet resection produced a significant increase in the neuroforaminal volume. On both sides, these maneuvers allowed adequate visualization of the herniated disc and several large fragments were removed from the intervertebral disc thereby decompressing the axilla between the exiting and traversing nerve root and below the dural sack centrallly. This allowed inspection of the anterior spinal canal and of the decompressed lateral recess. No additional free fragments or residual bony pathology that could further impinge spinal elements were found. At the end of the case, 40 mg of Depomedrol were injected epidurally for postoperative reduction of symptoms. The wound was closed with a horizontal matress stich using 4-0 monocryl. Intermil was applied as a dressing.
Narrative Description
The risks and benefits and alternative treatments have been thoroughly reviewed in clinic prior to today and the patient has reviewed the Center for Advanced Spinal Care patient education materials on this procedure. The patient has signed the informed consent for the direct posterior midline and paraspinal transforaminal decompression as outlined above. The patient was transported to the operating room, placed prone position on the Wilson frame, routine monitors were applied, and the back was prepped with CHG and Chloraprep, and draped in a standard sterile surgical fashion. The fluorscopy unit was sterilely draped and brought into the field for intraoperarive imaging and identification of surgical level. After local skin anesethesia was applied, small open incisions were made over the surgical level and the spine was accessed with the aid surgical tubular retractors, whose position was then radiographically verified intraoperatively. Facet and medial branch blocks were also performed during this portion of the case to achieve inra- and postoperative pain control. These procedures were also done at adjacent levels to address cross-innervation. On the left side the direct posterior decompression was done via a hemilaminotomy was performed and the lateral recess was decompressed surgically in a similar manner under continuous direct visualization of the the surgery. This resulted in partial removal of the lamina starting of the inferior margin and partial removal of the medial fect joint and removal of ligamentum flavum using rongeurs and drills. The intervertebral disc and the traversing nerve root were visualized. On the left side the transforaminal foraminotomy decompression was done via sequentially larger reamers were introduced into the neuroforamen with constant monitoring of the patients motor function in the lower extremity on the surgical side. The reaming allowed partial resection of the superior and inferior articular process at the surgical level. The decompression of the neural elements was further aided by removal of the hypertrophic superior and inferior articular process using power drills. a 3-0 Kerrison rongeur was also used during this portion of the procedure. A continuous radiofrequency probe was used to achieve hemostasis. An osteotome was used to perform a partial corpectomy with removal of a section of the posterior vertebral body to surgically release the traversing and exiting nerve roots that were entrapped under the facet complex due to significant hypertrophy of the facet joints as well as the ring apophysis of the superior and inferior vertebral bodies at the surgical level. In addition to a microdiscectomy, a partial pediculectomy was performed on the inferior pedicle of the surgical level to adequately decompress the traversing nerve root as well. The vertebral osteotomy, and partial facet resection produced a significant increase in the neuroforaminal volume. On both sides, these maneuvers allowed adequate visualization of the herniated disc and several large fragments were removed from the intervertebral disc thereby decompressing the axilla between the exiting and traversing nerve root and below the dural sack centrallly. This allowed inspection of the anterior spinal canal and of the decompressed lateral recess. No additional free fragments or residual bony pathology that could further impinge spinal elements were found. At the end of the case, 40 mg of Depomedrol were injected epidurally for postoperative reduction of symptoms. The wound was closed with a horizontal matress stich using 4-0 monocryl. Intermil was applied as a dressing.
Narrative Description
The risks and benefits and alternative treatments have been thoroughly reviewed in clinic prior to today and the patient has reviewed the Center for Advanced Spinal Care patient education materials on this procedure. The patient has signed the informed consent for the direct posterior midline and paraspinal transforaminal decompression as outlined above. The patient was transported to the operating room, placed prone position on the Wilson frame, routine monitors were applied, and the back was prepped with CHG and Chloraprep, and draped in a standard sterile surgical fashion. The fluorscopy unit was sterilely draped and brought into the field for intraoperarive imaging and identification of surgical level. After local skin anesethesia was applied, small open incisions were made over the surgical level and the spine was accessed with the aid surgical tubular retractors, whose position was then radiographically verified intraoperatively. Facet and medial branch blocks were also performed during this portion of the case to achieve inra- and postoperative pain control. These procedures were also done at adjacent levels to address cross-innervation. On the right side the direct posterior decompression was done via a hemilaminotomy was performed and the lateral recess was decompressed surgically. An endoscope was also used during this portion of the case to aid in the continuous direct visualization of the the surgery. This resulted in partial removal of the lamina starting of the inferior margin and partial removal of the medial fect joint and removal of ligamentum flavum using rongeurs and drills. The intervertebral disc and the traversing nerve root were visualized. On the right side the transforaminal foraminotomy decompression was done via sequentially larger reamers were introduced into the neuroforamen with constant monitoring of the patients motor function in the lower extremity on the surgical side. The reaming allowed partial resection of the superior and inferior articular process at the surgical level. The decompression of the neural elements was further aided by removal of the hypertrophic superior and inferior articular process using power drills. a 3-0 Kerrison rongeur was also used during this portion of the procedure. A continuous radiofrequency probe was used to achieve hemostasis. An osteotome was used to perform a partial corpectomy with removal of a section of the posterior vertebral body to surgically release the traversing and exiting nerve roots that were entrapped under the facet complex due to significant hypertrophy of the facet joints as well as the ring apophysis of the superior and inferior vertebral bodies at the surgical level. In addition to a microdiscectomy, a partial pediculectomy was performed on the inferior pedicle of the surgical level to adequately decompress the traversing nerve root as well. The vertebral osteotomy, and partial facet resection produced a significant increase in the neuroforaminal volume. On both sides, these maneuvers allowed adequate visualization of the herniated disc and several large fragments were removed from the intervertebral disc thereby decompressing the axilla between the exiting and traversing nerve root and below the dural sack centrallly. This allowed inspection of the anterior spinal canal and of the decompressed lateral recess. No additional free fragments or residual bony pathology that could further impinge spinal elements were found. At the end of the case, 40 mg of Depomedrol were injected epidurally for postoperative reduction of symptoms. The wound was closed with a horizontal matress stich using 4-0 monocryl. Intermil was applied as a dressing.
Follow Up
The patient was observed to be without any new neurologic signs or symptoms, transported to the recovery area, and discharged with standard written and verbal home going instructions. The patient is to see me in the office within 2 weeks. A follow up appointment has been scheduled for the patient. The patient did received prescriptions for postoperative pain medication in the office prior to surgery. The patient also received informational material on the use of the discharge medication and signed an educational consent form for the proper use of these medications. The patient was instructed to call my office with persistent fevers, chills, drainage from the wound, or increasing back or leg pain. The patient knows how to reach me by calling my office at 520-204-1495.