Sunday, November 6, 2011

A redo L4/L5 Discectomy

Yesterday I started a redo L4/L5 discectomy. I started the case strictly adherent to the principles of redo surgery.
Unfortunately I had dural tear with root herniation while exposing the left lateral bony margin of the previous laminectomy. Boss came for my rescue and helped in closing the defect. Finally we successfully completed the surgery however in this process I have learnt some important practical points in redo laminectomy and discectomies which can be added up to the universal principles of redo surgery for successful completion.

  1. Don't go too lateral in the earlier part of dissection as it can damage the radicular branches entering the spinal canal
  2. Always dissect sharply than with a monopolar till you identify dura at least at one point.( My dural injury was with monopolar dissection)
  3. Initial aim is to expose dura in a virgin area and follow it up to the desired extent.
  4. In recurrent cases, almost always, there will be adhesion between the dural sleeve and the extruded disc material and it is impossible to do discectomy without releasing these adhesions