Operative Note |
PROCEDURE: Bilateral decompressive cervical laminectomy, C4, C5, and C6. |
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SUMMARY: After
satisfactory general anesthesia, the patient was fixed in the Mayfield headrest, then turned prone over the Wilson frame and prepared
for surgery. The skin over the suboccipital neck and upper shoulders were shaven, scrubbed with Betadine scrub, painted with
Betadine paint, and draped for a sterile procedure. A midline 8 cm incision was made over the posterior spinous process of C3,
C4, C5, and C6. Dissection was carried down the deep cervical fascia, bleeding encountered, controlled with bipolar forceps. Bleeding was encountered and coagulated with bipolar cautery. The deep cervical fascia was incised on either side of the posterior
spines of C4, C5, and C6 and the paraspinous muscles were dissected away from the spine and lamina retracted laterally. A metallic
clip was placed in the posterior spine of C4 and the lateral x-rays taken confirm the exact anatomical location. Rongeurs were
used to remove the spine at C5 and the lamina at C5 out to the facet joints. Attention was then directed to the C6 lamina and
the spine. The spine was removed and the lamina was removed out to the facet joints and again attention was then directed to
C4 and the same performed. Once the laminectomy was complete, the ligamentum flavum was excised from the spinal dura. The dura remained intact. He did not have evidence of a radiculopathy, therefore foraminotomies were not done. Neural foramina
was inspected and seemed to be patent. Pledgets of gel foam were then cut and placed over the exposed dura. The paraspinous
muscles were allowed to fall back into place. Zero stay sutures were passed through the deep cervical fascia and muscle layer
to be tied later. Deep cervical fascia was then approximated in the midline with interrupted 2-0 Vicryl sutures. Then
the subcutaneous fat was approximated with interrupted 2-0 and 3-0 Vicryl sutures and half inch Steri-Strips were used for the skin
closure. Sterile postoperative dressings applied. The patient was then turned supine. The Mayfield headrest was
removed and the procedure was then terminated. The patient was awakened and transferred to the recovery room, having tolerated
the procedure quite well. At this point he is awake, talking, and moving all his extremities. Estimated blood loss for
the entire procedure was 125 cc. It was unnecessary to transfuse him. Sponge count, cottonoid count, instrument counts
were all correct.
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