Surgery 2/25. Buttock / leg ache started 3-4 weeks ago.
Below is the detail of the surgery.
INCISION AND EXPOSURE: Following the surgical time-out and radiographic localization utilizing fluoroscopy, which was interpreted intraoperatively by the surgeon, a 25-mm incision was made in a paramedian manner off of the midline and lateral to the pedicles on the left L3 and L4. Electrocautery was utilized to dissect down the lumbar fascia. Digital dissection was utilized to locate the Wiltse plane bilaterally and to palate the L2-3 and L3-4 facet joints.
INSTRUMENATION/SCREW PLACEMENT: Screws were placed utilizing the Globus ExcelsiusGPS robot according to the preoperative computerized plan. Globus headless Creo AMP screws were placed with 6.5 x 45 mm screws placed at all locations. All screws tested satisfactorily with triggered EMG testing and were visualized in both AP and Lateral planes utilizing fluoroscopy. All screws were satisfactory as interpretted intraoperatively by the attending surgeon.
ILIAC CREST BONE MARROW HARVEST: through a separate fascial incision, 5cc of cancellous bone marrow was harvested from the the left iliac crest for fusion purposes and used to impregnate Vitoss Tricalcium Phospate allograft for fusion purposes. Copious irrigation was performed and a layered closure was performed with vicryl and monocryl.
POSTERIOR SPINAL FUSION: Utilizing the retractor blades, the left L3 and L4 medial transverse processes, L3 pars, and the lateral aspect of the left L3-4 facet joint were identified. The posterolateral bony elements were denuded with electrocautery and then decorticated utilizing aggressive currettage. The space was packed with local autogenous bone graft and additional Vitoss with bone marrow aspirate in order to perform posterior spinal fusion posterolaterally at the facet.
POSTERIOR INSTRUMENTATION: A 55 mm rods was placed. Set screws were placed and then finally tightened utilizing torque-limiting screwdriver. The entire construct was then visualized utilizing fluoroscopic imaging in both AP and lateral views and noted to be in appropriate location. In this manner, posterior non-segmental instrumentation was performed.