OPERATIVE-PROCEDURE REPORTS
aware of the risks, benefits, alternatives and indications to surgery. They did know risks included hematoma, CSF leak, infection, potential need for revision surgery, potential lack of improvement, amongst other complications. They were well aware of that and agreed to proceeding.
DESCRIPTION OF PROCEDURE:
After the patient was consented and marked, he was brought to the operating room and placed in supine position. General anesthesia was inducted. Preoperative antibiotics were administered. He was carefully flipped onto a Jackson prone bed. All pressure points were padded. The thoracic area was prepped and draped in the usual fashion. A #10 blade was used to make a midline skin incision. A subperiosteal dissection was performed to expose the posterior elements of T4, T5 and T6. Intraoperative x—ray confirmed the correct level. A high—speed drill and Leksell rongeur were used to perform a partial T5 and partial T6 laminectomy. We thought we would start with that and extended as needed. The exoscope was brought in for visualization. There were no changes in NEPs or SSEPs at any point. In fact, there was slight improvement in the motors in the lower extremities at the end of the surgery. After the exoscope was brought in, the dura was carefully opened and tacked up. An obvious thickened arachnoid web was visualized and it was sectioned sharply with microscissors in different areas until several segments were removed. We continued to that until I thought there was excellent restoration of spinal flow in that area. The obvious deformation of the cord was apparent and at that point, I was very happy with the decompression as well as the restoration of OSF flow. We ensured that there was good hemostasis. The dura was closed using 5—0 Prolene and after a Valsalva ensured no CSF leak, we placed a small piece of Gelfoam without significant pressure as well as Tisseel for further closure of the CSF area. At that point, we ensured there was good hemostasis in the soft tissue. A subfascial drain was placed. The fascia and the soft tissue was closed using Vicryl suture and the skin was closed using nylon suture. There were no obvious complications. I was present for the entire case.
Ali A. Baaj, ND
AAB:NTS
D:02/10/2022 13:03 NST
T:02/10/2022 22:37 NST
Printed: 2/14/2022 12:33 MST Page 2 of 3