Neurosurgery

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PREOPERATIVE DIAGNOSIS:  Herniated nucleus pulposus L5-S1 on the left.

POSTOPERATIVE DIAGNOSIS:  Same.

PROCEDURE PERFORMED:  Diskectomy L5-S1 on the left.

SURGEON:  M, MD.

DESCRIPTION OF PROCEDURE:  After induction of general endotracheal anesthesia, the patient was turned prone and placed in the knee-chest position utilizing the Andrews spinal surgery frame.  The lumbar sacral area was prepped and draped in a sterile fashion.  Two needles were placed in the two lumbar spinous processes.  A lateral _____ brace was obtained.  Then intubation was placed in the spinal processes of L5, indigo carmine was infiltrated to serve as a marker throughout the remainder of the case.  Standard technique was used to expose the spine at L5-S1 on the left.  A high-speed air drill was used to perform a laminotomy of the inferior aspect of L5 and remove the medial 1/3 of its inferior articular facette.  The ligamentum flavum was attached from the undersurface of L5.  We decompressed the lateral recess at L5-S1 on the left.  We then identified nerve root compression from disk material. Accordingly the disk was incised and using intravertebral disk rongeurs disk material was removed.  At the completion of the diskectomy we could palpate along the course of the nerve root.  It was free of any compression.  The wound was then irrigated out copiously and closed in layers of absolving suture material with the exception of the skin, which was approximated with subcutaneous suture of Vicryl and a Steri-Strip.  A dry, sterile dressing was applied.  The patient was turned supine, extubated, and brought to Recovery Room in stable condition.

PREOPERATIVE DIAGNOSIS:  Spinal stenosis L3-L4, and L4-L5.

POSTOPERATIVE DIAGNOSIS:  Same. 

PROCEDURE PERFORMED:  Decompression at L3-L4 and L4-L5.

SURGEON:   M, MD.

DESCRIPTION OF PROCEDURE:  After the induction of general endotracheal anesthesia, the patient was turned prone and placed in the knee-chest position, utilizing the Andrews spinal surgery frame.  The lumbar sacral area was prepped and draped in sterile fashion.  Two needles were placed in the two lumbar spinous processes.  Intubating was placed in the spinous processes of L3, indigo carmine was infiltrated to serve as a marker throughout the remainder of the case.  Standard technique was used to expose the spine from L3 down to L5.  A bone monitor was used to move the spinous processes at L3, L4 and the upper aspect of L5.  A high-speed air drill was used to thin out the lamina and facette at these levels.  The ligamentum flavum was attached to the undersurface of L3 and removed the Kerrison punch.  The midline and then each lateral recess compressed out the level of its respective pedicle with the Kerrison punch.  We palpated along the course of each nerve root to make sure that we were free of any compression and we were.  The wound was then irrigated out copiously and closed in layers of absorbable suture material, with the exception of the skin, which was approximated with subcutaneous suture of Vicryl and a Steri-Strip.  A dry, sterile dressing was applied.  The patient was turned supine, extubated, and brought to Recovery Room in stable condition.

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