Far-Lateral Microdiskectomy and Lateral Facetectomy Operative Sample
DESCRIPTION OF OPERATION: The patient was brought to the operating room, induced, and intubated without difficulty. The patient received IV antibiotics in the holding area. He was given 10 mg of Decadron IV. He was rolled prone on the Williams frame table, and the lumbosacral region of his spine was scrubbed with a Betadine scrub brush and washed with alcohol.
With the aid of the C-arm fluoroscopy unit, a 6 cm parasagittal incision was marked out in the L4-5 region. This area was prepped and draped in sterile fashion. It was infiltrated with 1% Xylocaine with epinephrine and opened with a 10 blade, dissecting down to the fascia, opening the fascia in blunt dissection through the lumbar musculature to the facet at L4-5. The L5 facet was confirmed with the C-arm fluoroscopy unit.
Further dissection down identified the transverse process of L5. Dissection rostrally continued to the inferior edge of the L4 transverse process. A deep McCullough retractor was placed in the field and the microscope was brought in at this point.
The Midas Rex and AM-8 drill bit were used to drill away portions of the lateral facet. The intertransverse musculature was carefully cauterized and cut with microscissors. Blunt dissection down through fat led to identification of the passing L4 nerve root; this was retracted laterally.
Bipolar cautery was used to cauterize the vascular structures and the disk space was identified. A micro Jannetta dissector was placed into the disk space and the C-arm fluoroscopy unit again confirmed this correct location.
A micropituitary was then used to remove lateral disk fragments. Once these disk fragments were removed from the lateral aspect of the disk, more room was freed up. Probing slightly rostral to the disk space, a few lumps of disk material were seen just rostral to the disk space, as expected. These were pulled out with the micropituitary. Copious irrigation at this point was followed with inspection of the L4 nerve root; it appeared freed up at this point.
Further irrigation was followed with placement of FloSeal in the area. Bony edges were waxed. Closure then began.
The lumbodorsal fascia was closed with interrupted 0 Vicryl sutures. Superficial fascial layers were closed with interrupted 2-0 Vicryl sutures. The skin was closed with a 4-0 subcuticular stitch. Steri-Strips were applied and a dressing was placed on the patient’s back. The patient awoke in good neurologic condition and was taken to the recovery room.
