nlbarnes
Expert
Doctor has 22558, 22853, 22612, 22840
Shouldn't 22840 be 22845 and any other corrections?
POSTOPERATIVE DIAGNOSES:
1. Isthmic spondylolisthesis, L5-S1.
2. Bilateral pars defects chronic L5.
3. Foraminal stenosis, bilateral L5-S1.
PROCEDURES:
1. Anterior lumbar interbody fusion with placement of interbody
fusion device and buttress plate fixation, L5-S1.
2. Posterior spinal fusion with instrumentation, L5-S1.
IMPLANTS:
SeaSpine a-POD PEEK/ titanium interbody fusion device L5-S1 and
SeaSpine spin plate titanium buttress plate fixation, L5-S1.
Posterior instrumentation was Medtronic Legacy titanium pedicle screw
system, L5-S1.
DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room, placed in a supine
position on the gurney, where general anesthesia obtained. The
patient was then carefully transitioned to the operating table to
allow for anterior approach to the lumbar spine. All pressure points
were appropriately padded. Abdomen was then prepped and draped in
normal sterile fashion. Surgical time-out completed. Appropriate
operative level was confirmed with intraoperative fluoroscopy. Once
appropriate levels identified, Dr. D then performed an
anterior exposure of the lumbar spine at L5-S1 and this will be
dictated under separate operative note. Once Dr. D provided
exposure, annulotomy was created at L5-S1 after appropriate
confirmation of visualization on x-ray of the appropriate operative
level. Annulotomy was created anteriorly. Serial curettage of the
disk space was then performed. Appropriate size implant was then
selected to match patient anatomy, and with the placement of the
anterior interbody device, there was excellent interference fit of the
implant as well as reduction of the spondylolisthesis approximately
50% which was simply the anterior based interbody procedure alone.
The appropriate size implant was selected, appropriate position within
the intervertebral space, and then buttress plate fixation was engaged
spanning the intervertebral space creating fixation at L5 and S1
respectively at the point of implant fixation. With stable anterior
end plate fixation completed, the anterior component of the procedure
was completed. Final fluoroscopic imaging showed excellent position
of the implant on both AP and lateral fluoroscopic imaging and all
sponges and instrumentation removed from the abdomen. The wound was
then closed in layers and sterile dressing was placed. The patient
was then carefully rolled to the prone position on Jackson table with
all pressure points appropriately padded. Back was then prepped and
draped in normal sterile fashion. Surgical time-out was completed.
Two paramedian incisions were made over the starting points of the L5
and S1 pedicles respectively. Skin and subcutaneous tissues dissected
sharply. The investing fascia of the posterior spinal muscle was then
divided longitudinally using Bovie electrocautery. Blunt dissection
of the posterior spinal musculature was then performed. Using Bovie
electrocautery, the sacral ala of S1 was exposed bilaterally. The
transverse process of L5 were exposed bilaterally. These were
decorticated using a high-speed burr and then the decorticated bone
was mixed with some additional beta-tricalcium phosphate and then this
graft material was packed densely over the exposed decorticated bony
elements from L5-S1 respectively. Cannulated needles were then
utilized to cannulate the pedicles of L5 and S1 respectively with care
taken to maintain the needle tips lateral to the medial pedicle wall
during the traverse of the pedicles bilaterally. Guidewires were then
placed through the pedicle into the vertebral bodies bilaterally with
excellent wire position confirmed with AP and lateral fluoroscopic
imaging. The pedicle channels were then carefully tapped.
Appropriate-sized screws were then selected to match patient anatomy,
seated over the guidewires through the pedicles and the vertebral
bodies bilaterally with excellent screw purchase achieved at all 4
screw points. The connecting rods for the system were then placed
within the multiaxial heads of the system and with final tightening,
there was some additional reduction of the spondylolisthesis was well
as restoration of lordosis using the lordosis created on the Jackson
table to maximize lordotic position at L5-S1. Final tightening of the
Shouldn't 22840 be 22845 and any other corrections?
POSTOPERATIVE DIAGNOSES:
1. Isthmic spondylolisthesis, L5-S1.
2. Bilateral pars defects chronic L5.
3. Foraminal stenosis, bilateral L5-S1.
PROCEDURES:
1. Anterior lumbar interbody fusion with placement of interbody
fusion device and buttress plate fixation, L5-S1.
2. Posterior spinal fusion with instrumentation, L5-S1.
IMPLANTS:
SeaSpine a-POD PEEK/ titanium interbody fusion device L5-S1 and
SeaSpine spin plate titanium buttress plate fixation, L5-S1.
Posterior instrumentation was Medtronic Legacy titanium pedicle screw
system, L5-S1.
DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room, placed in a supine
position on the gurney, where general anesthesia obtained. The
patient was then carefully transitioned to the operating table to
allow for anterior approach to the lumbar spine. All pressure points
were appropriately padded. Abdomen was then prepped and draped in
normal sterile fashion. Surgical time-out completed. Appropriate
operative level was confirmed with intraoperative fluoroscopy. Once
appropriate levels identified, Dr. D then performed an
anterior exposure of the lumbar spine at L5-S1 and this will be
dictated under separate operative note. Once Dr. D provided
exposure, annulotomy was created at L5-S1 after appropriate
confirmation of visualization on x-ray of the appropriate operative
level. Annulotomy was created anteriorly. Serial curettage of the
disk space was then performed. Appropriate size implant was then
selected to match patient anatomy, and with the placement of the
anterior interbody device, there was excellent interference fit of the
implant as well as reduction of the spondylolisthesis approximately
50% which was simply the anterior based interbody procedure alone.
The appropriate size implant was selected, appropriate position within
the intervertebral space, and then buttress plate fixation was engaged
spanning the intervertebral space creating fixation at L5 and S1
respectively at the point of implant fixation. With stable anterior
end plate fixation completed, the anterior component of the procedure
was completed. Final fluoroscopic imaging showed excellent position
of the implant on both AP and lateral fluoroscopic imaging and all
sponges and instrumentation removed from the abdomen. The wound was
then closed in layers and sterile dressing was placed. The patient
was then carefully rolled to the prone position on Jackson table with
all pressure points appropriately padded. Back was then prepped and
draped in normal sterile fashion. Surgical time-out was completed.
Two paramedian incisions were made over the starting points of the L5
and S1 pedicles respectively. Skin and subcutaneous tissues dissected
sharply. The investing fascia of the posterior spinal muscle was then
divided longitudinally using Bovie electrocautery. Blunt dissection
of the posterior spinal musculature was then performed. Using Bovie
electrocautery, the sacral ala of S1 was exposed bilaterally. The
transverse process of L5 were exposed bilaterally. These were
decorticated using a high-speed burr and then the decorticated bone
was mixed with some additional beta-tricalcium phosphate and then this
graft material was packed densely over the exposed decorticated bony
elements from L5-S1 respectively. Cannulated needles were then
utilized to cannulate the pedicles of L5 and S1 respectively with care
taken to maintain the needle tips lateral to the medial pedicle wall
during the traverse of the pedicles bilaterally. Guidewires were then
placed through the pedicle into the vertebral bodies bilaterally with
excellent wire position confirmed with AP and lateral fluoroscopic
imaging. The pedicle channels were then carefully tapped.
Appropriate-sized screws were then selected to match patient anatomy,
seated over the guidewires through the pedicles and the vertebral
bodies bilaterally with excellent screw purchase achieved at all 4
screw points. The connecting rods for the system were then placed
within the multiaxial heads of the system and with final tightening,
there was some additional reduction of the spondylolisthesis was well
as restoration of lordosis using the lordosis created on the Jackson
table to maximize lordotic position at L5-S1. Final tightening of the