WSHIMA - Case 20: Decompressive Laminectomy
PREOPERATIVE DIAGNOSIS: L1-L2 stenosis.
POSTOPERATIVE DIAGNOSIS: L1-L2 stenosis..
PROCEDURE: L1-L2 decompression laminectomy and bilateral medial facetectomy. .
COMPLICATIONS: None.
OPERATIVE INDICATIONS: Pt. is active 76 -year-old male. He is having increasing difficulty with standing and walking secondary to back and buttock pain. He has moderate central stenosis at L1 and L2. For diagnostic, as well as therapeutic purposes, he underwent an L1-L2 epidural steroid injection. He had excellent pain relief but only for a very short term. In this scenario, we have offered him an L1-L2 laminectomy and bilateral medial facetectomy.
DESCRIPTION OF PROCEDURE:. His lumbar spine was initialed by myself. He was then taken to the operating room theater, where he succumbed to a general endotracheal anesthetic where he was placed prone on a Jackson table with a Wilson frame. All bony prominences were well padded. Bilateral SCDs were put in place. His lumbosacral spine was prepped and draped in the standard sterile fashion. A timeout was held correctly identifying the patient, the procedure and the levels of the procedure with the operating room staff. At that time, we also confirmed he had received 2 grams of IV Ancef within 1 hour of the incision.
Lateral fluoroscopy was brought in, identifying the L1-L2 level. Then a midline incision was made directly over the vertebral bodies. This incision was carried down sharply through the skin. Bovie cautery was used to dissect through the subcutaneous tissue, down to the fascia. The fascia was split along the spinous processes bilaterally. Subperiosteal dissection revealed the L1-L2 spinous processes and lamina. Lateral fluoroscopy again confirmed our level. A Gelpi retractor was put in place. A Leksell rongeur was used to take down the anterior portion of the L1 spinous process and superior portion of the L2 spinous process. Then, with the use of a 3 and 4 mm Kerrison, a decompressive laminectomy was performed, taking down the inferior 2/3 of the L1 and superior portion of the L2 lamina freeing the lumbar nerve. Bilateral medial facetectomies were performed. The ligamentum flavum was reflected. A lateral fluoroscopic view was obtained delineating the extent of our laminectomy. Then, the wound was copiously irrigated. The fascia was closed with 0 Vicryl followed by 2-0 Vicryl in the subcutaneous tissue, then a 3-0 Stratafix stitch was placed subcuticularly. The wound was infiltrated with Marcaine. A sterile dressing was applied. The patient was transferred to the hospital gurney.