EXAMPLE
Emeka Nchekwube, M.D.
OPERATIVE REPORT
________________________________
ANESTHESIOLOGIST: Steven Wai. M.D.
ANESTHESIA: General
PREOPERATIVE DIAGNOSES: C6-C7 disc herniation.
POSTOPERATIVE DIAGNOSES: C6-C7 disc herniation.
PLANNED PROCEDURE:
1.
Anterior cervical microsurgical discectomy, C6-C7.
2.
Anterior cervical microsurgical foraminotomy, C6-C7,
bilaterally.
3.
Anterior fusion using a NuVasive human allograft struts and
demineralized bone matrix gel, C6-C7.
4.
Anterior stabilization using Abbott Spine ThinLine anterior
cervical placement screws, C6-C7.
FINDINGS: The patient had soft degenerative disc at C6-C7. The
C6-C7 spinal segment was hypermobile. There was a large free
fragment disc impacted in the left C7 level foramina.
OPERATIVE PROCEDURE: Following satisfactory general endotracheal
anesthesia, the patient was placed supine with the head in
maintained neutral. A Holter skeleton traction system was
applied for continued skeletal traction, using a 5-lb weight.
Next, the anterior cervical and upper chest region was prepped
and draped in the usual fashion. The operation commenced with a
transverse incision placed at the lower cervical crease on the
right side. The incision measured an inch and a half in length
and was taken down sharply through the underlying subcutaneous
tissue and through the platysma to expose the sternocleidomastoid
muscle. The lata was separated from the adjacent strap muscle.
The carotid sheath was identified and mobilized laterally, as the
prevertebral space was entered. Next, the anterior vertebral
surface at C6-C7 was identified by gross inspection. This was
subsequently confirmed with intraoperative radiograph using a
marker. Following this, the longus colli muscle was mobilized on
either side at C6-C7. A Cloward retractor assembly was now
brought into the field and applied to the longus colli muscle,
followed by a reciprocating retractor without teeth to create a
generous exposure from C6-C7. Next, the anulus was opened at C6C7 and the disc space emptied grossly of soft degenerative disc
material. Next, the vertebral spreader was placed in the left
disc space and the vertebral body distracted about 4 mm.
Additional gross disc removal was carried out under direct
inspection, as far as the eye could see. Following that, the
microscope was then brought into the field and under the
microscope, additional disc material was removed, down to the
posterior longitudinal ligament, which was now visualized. More
end plates were now removed with Anspach high-speed precision
drill. Following this, using microcurettage and Kerrison
rongeur, the rest of the disc space was cleared from one side to
the other into the nerve root foramen which was generously
opened, revealing large intraforaminal disc fragments, impacted
against the exiting C7 nerve root on the left side. This was
carefully and meticulously removed until clear. A brisk epidural
venous bleeder indicated a good and satisfactory decompression.
The same procedure was carried out on the right side where there
were no intraforaminal disc fragments found. The wound was
copiously irrigated and after satisfactory hemostasis the
microscope was put away.
Next, using NuVasive sizing templates the appropriate size graft
material 9 mm) was chosen. The central canal of the graft was
filled in with demineralized bone matrix gel. The graft was then
secured with the special applicator and recessed into the disc
space and countersunk.
The Abbott Spine ThinLine anterior cervical plate set was brought
onto the field and under x-ray control, and using temporary
positional pins, the appropriate size plate was chosen.
Following this, using an awl, the anterior vertebral bodies were
separated followed by placement of 4.0 x 14 mm screws which were
secured and locked in place in the usual fashion.
Final radiographs were taken, showing a satisfactory construct.
The wound was then irrigated copiously, and, after satisfactory
hemostasis, a #7 Jackson-Pratt drain was placed in the depth of
the wound and brought out through a separate stab wound incision.
The wound was closed in incremental and anatomically in layers
with 3-0 Vicryl suture for the fascia of the sternocleidomastoid
muscle, reapproximating the adjacent strap muscles. The
platysma was closed using a running fashion with 4-0 Vicryl
suture. Next, the subcuticular layer was closed in a running
inverted fashion with 5-0 Vicryl sutures. The skin was brought
together with Steri-Strips. Sterile dressing was applied and the
patient left the operating room in satisfactory condition.
ESTIMATED BLOOD LOSS: 40 mL.