DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Herniated lumbar disk at L5-S1 on the left.
POSTOPERATIVE DIAGNOSIS: Herniated lumbar disk at L5-S1 on the left.
OPERATION PERFORMED:
1. Left L5-S1 hemilaminectomy and diskectomy.
2. Microdissection using the operating room microscope.
SURGEON: John Doe, MD
ANESTHESIA: General.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old woman with a three-month history of severe left leg pain in the distribution of the S1 nerve root. An MRI showed evidence of a freely herniated disk fragment causing severe compression of the exiting S1 nerve root. She had an epidural steroid injection, which failed to relieve her symptoms, and she elected to proceed ahead with the option of open microsurgical fragmentectomy.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed under general anesthesia. She was then placed prone on a Wilson frame. All bony prominences were inspected and padded prior to sterile draping. The lumbosacral area was then prepped and draped in the usual sterile fashion.
Using a #15 blade knife, the skin was incised in the midline, and monopolar cautery was used to dissect through the subcutaneous tissue to open the fascia and reflect paraspinal muscles laterally exposing the posterior elements at L5-S1 on the left. A self-retaining Taylor retractor was placed, and lateral fluoroscopic imaging confirmed proper localization at this level. The microscope was brought into the field and used to assist with performing a microsurgical hemilaminotomy. The Midas-Rex drill was used to bur down a portion of the adjacent L5 and S1 laminar segments on the left exposing the underlying ligamentum flavum. The ligamentum flavum was opened with a micro Penfield #4 dissector and the lateral portion removed with a 2 mm micropunch. This exposed the takeoff of the S1 nerve root. The disk itself appeared to be intact. A freely herniated disk was found to be firmly adherent to the takeoff of the S1 nerve root. Considerable microsurgical dissection was required to free the fragment from the S1 nerve root. The entire fragmentectomy was performed working in the axilla of the S1 nerve root. There was a very large fragment present here.
The wound was then irrigated with antibiotic solution. Duramorph was placed in the epidural space and 0.5% Marcaine in the subcutaneous tissues. The fascia was then reapproximated with interrupted 0 Vicryl sutures, and interrupted 3-0 Vicryl sutures were used to reapproximate the subcuticular layer. Dermabond was then placed as a sterile dressing. The patient was extubated in the operating room and transferred to the recovery room in stable condition. There were no complications.
