DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Cervicalgia.
2. Bilateral shoulder pain.
3. Left upper extremity pain.
4. Dynamic instability, C5-6.
POSTOPERATIVE DIAGNOSES:
1. Cervicalgia.
2. Bilateral shoulder pain.
3. Left upper extremity pain.
4. Dynamic instability, C5-6.
OPERATIONS PERFORMED:
1. Anterior cervical diskectomy and fusion, C5-6.
2. Partial vertebrectomy, C5, for decompression.
3. Use of tricortical iliac crest bone graft for fusion.
4. Use of anterior instrumentation over two to three vertebral segments.
5. Use of neuromonitoring of the spinal cord.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 15 mL.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: After informed consent, the patient was taken to the operating room where general anesthesia was induced. She was placed supine on the operating table where pressure points and extremities were padded in the routine fashion. She was given routine preoperative prophylactic antibiotics, and neuromonitoring and anesthetic devices were attached. The time-out identified the operative site. The neck and left iliac crest were prepped and draped in a standard sterile fashion.
We started by making an incision from midline out to the left medial border of the sternocleidomastoid with the knife. We used Bovie cautery to dissect down the platysma. The platysma was divided. We then followed the plane along the medial border of the sternocleidomastoid down to the point between the carotid sheath and esophagus and trachea. We followed this down bluntly to the prevertebral fascia, which we cleared off with a Kittner elevator. We then placed a spinal needle in the C5-6 disk space and confirmed position with C-arm fluoroscopy. We then choked the internal longitudinal ligament and divided this out bilaterally at the longus colli with a Bovie. We then placed self-retaining retractor and had the anesthesiologist look down and reinflate the ET cuff after 5 seconds.
Following this, we had a 15-blade for annulotomy. We used pituitaries, curettes, and Kerrisons to continue diskectomy. We placed Caspar self-distraction pin and gently distracted the disk space. We then brought in a bur and burred down the inferior body of C5 down to the posterior vertebral body. There was some retrolisthesis at C5-6 and we again used the bur and burred down this posterior and inferior portion of C5.
Following this, we were then able to find the posterior longitudinal ligament and elevate this with a micro nerve hook. We then used 1 mm Kerrison and divided the PLL along its entirety out to the neural foramen where foraminotomies were performed. At this time, we were able to easily pass the medium size nerve hook without difficulty. We then continued to prepare the endplates with curettes as well as the bur until it was satisfactorily prepared. At that time, we filled the incision with copious irrigation.
We then turned our attention down to the left iliac crest. We made an incision over the iliac crest with a 15-blade. We then used the Bovie to dissect down over the iliac crest. We elevated the fascia using Bovie cautery off the inner and outer table and were able to protect this with a pair of elevators. We then used the 7 mm dual-blade reciprocating saw and harvested the iliac crest bone graft without difficulty. We then obtained hemostasis and used copious irrigation after doing this.
We were able to easily close the fascia using 0 Vicryl in a figure-of-eight fashion. We again copiously irrigated and closed the subcutaneous tissue with 2-0 Vicryl, interrupted fashion, followed by 3-0 Vicryl, interrupted fashion, and 4-0 Monocryl running subcuticular suture for the skin. Dermabond and Steri-Strips were applied followed by sterile dressing. Marcaine 0.5% was injected for analgesia. We then placed a sterile dressing without difficulty.
We turned our attention back to the neck. We continued to prepare the disk space with a rasp and we placed this iliac crest bone graft without difficulty. We then got a 12 mm plate held with provisional fixation pins. We then got AP and lateral fluoroscopy to confirm position. Following this, we placed 12 mm screws x2 at C5 and C6 without difficulty. We then were able to again obtain AP and lateral fluoroscopy to confirm this excellent position.
Following this, we tightened the screws completely. We then copiously irrigated and obtained excellent hemostasis. We closed the platysma using 2-0 Vicryl interrupted fashion. We again irrigated and closed subcutaneous tissue with 3-0 Vicryl interrupted fashion and 4-0 Monocryl running subcuticular stitch for the skin. Dermabond and Steri-Strips were applied followed by sterile dressing. The sponge and needle counts were correct x2. There was no change whatsoever on neuromonitoring at the spinal cord throughout this procedure. The patient was awakened and was taken to recovery in stable condition. The patient did have her rigid collar applied prior to leaving the operating room.
