Discectomy: Lumbar

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Recurrent disc herniation, most common
  • Primary disc herniation
  • Cauda equina syndrome
CONTRAINDICATIONS
  • Spinal stenosis
  • Calcified herniation
  • Severe facet degenerative disease
  • Predominant symptom of back pain
EQUIPMENT
  • Headlamp
  • Surgical loupes or operating microscope
  • Intraoperative x-ray equipment
  • Self-retaining or handheld retractors
  • Bipolar electrocautery
  • Curets
  • Pituitary rongeur
  • Angled Kerrison rongeur
  • No. 11 blade
  • Penfield No. 4 dissector
  • Love nerve root retractor
  • Gelfoam
  • Small cottonoids
  • Microblunt hook
  • Pituitary forceps
ANATOMY
  • Lumbar spine: five vertebrae with associated nerve roots (named for pedicle above); disc herniation affects nerve root below.
  • Intervertebral disc: inner soft nucleus pulposus and an outer annulus fibrosis, which is attached to surrounding structures by collagen fibers.
  • Neural elements are highly organized and consistently arranged.
  • Cephalad roots lie laterally; caudal roots lie centrally.
  • The motor roots are ventral to the sensory roots at all levels and are held in place by the arachnoid mater.
  • The dorsal root ganglion lies at the level of the intervertebral foramen.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Monitor neurological function.
  • Allow the patient to turn in bed at will and to stand with assistance to go to the bathroom.
  • Use oral pain medication, muscle relaxants, and bladder stimulants as necessary.
  • Discharge is usually the same day as the surgery, when the patient can walk and void.
  • Limit sitting and riding in a car initially, avoiding long trips for 4 to 6 weeks.
  • Progress walking daily, but avoid lifting, bending, and stooping for several weeks.
  • Physical therapy should initially include gentle isotonic leg exercises and stretching; begin core strengthening between the first and third weeks.
  • Return to work in 2-3 weeks if able to stand and walk, but avoid lifting while at work, 4-6 weeks for jobs requiring prolonged sitting, and 6-8 weeks for jobs requiring heavy lifting.
COMPLICATIONS
  • Neurological injury including nerve root injury
  • Vascular injury
  • Thrombophlebitis or pulmonary embolism
  • Epidural fibrosis
  • Dural tear
  • CSF leak
  • Pseudomeningocele or CSF fistula formation
  • Meningitis
  • Postoperative discitis
  • Infection
  • Recurrence of symptoms
  • Postoperative cauda equina lesions
  • Visceral injury
RESULT ANALYSIS

Lumbar disc removal for the treatment of disc herniation enjoys a high rate of success with a low rate of serious complications. This is especially true when careful patient evaluation and selection is used to identify patients for whom surgical intervention is most appropriate.

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