Download Operative record sheet for Decompressive Laminectomy Date of

FM-OP-0907-11
Operative record sheet for Decompressive Laminectomy
Date
of
operation
Operation room
16
มกราคม
2560
1
Surgeon พ.บดินทร์ Assistant 1. อรรถพล
Instrumentnurse
หทัยรัตน์ Circulate nurse สุมลรัตน์
Anesthesiologist
พญ. ยุพานวล
Anesthetic method
GA + ET
Pre-operative status
Pre medication
1000 ml
Anesthetis ชิดชนก
ASA II
NPO
AMN
+5%D/N/2
80 ml. /hr
Pre-operative diagnosis
Spinal stenosis L2 –
5
Post operative diagnosis
Operation
SAME AS SBOVE
DCL +FUSION L2 – L5 WITH PEDICLE
SCREW + transverse 1 ตัว
Incision
POSTERIOR MIDLINE
blood loss
1,100
ml
Estimate
Operative time
Sponge count
AM
Tourniquet time
-
complete
Findings
HYPERTHROPHY FACET AND LIGAMENTUM FLAVUN L15, COMPRESSION NERVE ROOT L2-5 ROOT , SEVERE L45,lumbar scoliosis L4-5
Procedure
Placed the patient in a prone position with arms at 90° max abduction and
flexion to prevent axillary nerve injury, foam padding on chest and ASIS
with gel pads on knees under adequate anesthesia on radiolucent Wilson
spinal frame.
Made skin incision direct posterior approach to spine overlying the spinous
processes of entile vertebra between paraspinal muscles.
Dissected subcutaneous tissue down to fascia and use gelpi retracture.
Cauterized lumbodorsal fascia over spinous processes to just lateral of
midline.
Subperiosteal dissection with Cobb dorsal to volar along spinous processes
Dissect cranial to caudal down to lamina.
Once down to lamina used Cobb to strip laterally along lamina until facet
capsules exposed
Place cerebellar retractors for better visualization.
Used the hohmann retracter to strip muscular attachments to facets in
order to expose lateral
gutters and transverse processes and par
interarticularis cranial to caudal.
Confirmed exposed levels with fluoroscope.
Pedicle screws was inserted at inferolateral aspect of the intersection
of facet and transverse process.
Decorticate entry site with rhongeur and awl to open the cortex then
place curve probe into pedicle track until significant resistance is felt
(anterior cortex of vertebral body).
Inserted balltip probe to check floor, medial, inferior walls of pedicle.
Used tap 5 mm and recheck with balltip probe.
Placed the screws and checked with fluoroscope then insert pedicle
screws cranial to caudal.
Removed spinous processes of operative levels with rongeur.
Central canal decompression began with decompression into canal into
inferior half of lamina of cephalad vertebrae
first with small curette.
Gently retracted ligamentum flavum and resect remaining lamina and
ligamentum with Kerrison rongeur of cephalad vertebra.
Resected ligamentum from superior lamina of inferior lamina use Kerrison
to resect caudad lamina from
inferior vertebra. Foraminal decompression began by used osteotome to
remove inferior articular facet then kerrison to undercut
medial edge of superior facet of caudad vertebra until medial edge of
pedicle visualized.
Identify osteophytes that could impinge exiting nerve root around pedicle
undercut remaining superior facet
using kerrison rongeur.
PL fusion was done with autogenous
bone graft between
transverse process.
Irrigation and hemostasis then closure layer by layer.
Name of patient
นางแสงประทีป ไกรศร
Department of service
Ortho
Age 63
Ward
ปี
HN 0139583
ศัลยกรรมชาย
Surgeon
AN
600000600
พ. บดินทร์