DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Multilevel lumbar spinal stenosis.
POSTOPERATIVE DIAGNOSIS: Multilevel lumbar spinal stenosis.
OPERATIONS PERFORMED: Bilateral laminectomies at L1, L2, L3, L4, and L5 with bilateral medial facetectomies and foraminotomies.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, PA-C
ANESTHESIA: General anesthesia, endotracheal intubation.
COMPLICATIONS: No complications.
DISPOSITION: Stable to the recovery room.
OPERATIVE INDICATIONS: The patient presents with persistent neurogenic claudication in both lower extremities arising from his spinal stenosis, expanding from L1 to L5 as shown on his lumbar MRI. The patient’s symptoms have been progressive in nature and are currently refractory to nonoperative measures. We have discussed with him the diagnosis, treatment options, risks, and benefits. The patient expresses his understanding and consents to the procedure.
The patient had near-occlusive lesions at L1-2, 2-3, 3-4, and 4-5 which required very tedious dissection to avoid a dural sac injury. The decompression was achieved without injury to the thecal sac.
DESCRIPTION OF PROCEDURE: After having received preoperative IV antibiotics, the patient arrived in the operating room where general anesthesia was induced by the anesthesia department. A Foley catheter was inserted. Bilateral knee-high pneumatic boots were applied, and the patient was carefully rolled into a prone position on the table. All pressure-sensitive areas were carefully protected. The hips and knees were gently flexed. The lumbar field was isolated with plastic drapes and then prepped and draped in the usual sterile fashion. A time-out was held to identify the patient’s name, diagnosis, and surgical procedure.
Using a standard midline incision, the incision was carried down through the skin and subcutaneous tissues, exposing the posterior elements in the lumbar spine as indicated by intraoperative lateral radiograph. Using Midas Rex and Cloward punches, bilateral laminectomies at L1, 2, 3, 4, and 5 were performed. Bilateral medial facetectomies and foraminotomies were performed as well. This required very tedious dissection because of high-grade stenosis at the multiple levels. Thorough decompression was achieved, however, without a dural injury.
Examination of the thecal sac revealed it to be intact. The combination of bone wax, bipolar electrocautery, and Oxycel were used to provide hemostasis. The wound was copiously irrigated with sterile saline. A flat Jackson-Pratt drain was placed adjacent to the dura and exited through the separate stab wound.
The wound was then closed in layers with 0 Vicryl, 2-0 Vicryl, and a running subcuticular 3-0 Vicryl stitch. The subcutaneous plane was irrigated with a dilute iodine solution followed by saline. Skin edges were injected with 30 mL of 0.5% plain Marcaine, half-inch Steri-Strips, and a sterile dry dressing was applied. The patient was rolled into his hospital bed and taken to the recovery room in stable condition. There were no apparent complications, and the patient tolerated the procedure well.
