Brendan. Posted Fri 08th of June, 2012 14:20:32 PM
Thank you. Here is the op report:
We created a linear skin incision from the spinous process of T10-L1, elevated soft tissue bilaterally, identified immediately hematoma in the paraspinous musculature at the T11-12 junction.
We then obtained serial x-ray, dissected down to the transverse process of L1, the tranverse process rib junction of T12 and T11.
There was an obvious rent in the interspoinous ligament at T11-12 with basing an auto laminectomy of T11-12 lamina by virtue of fracture. This was removed by laminectomy by a compination of hand and Midas Rex instrumentation. Underlying this was encountered epidural hematoma of roughly 4 mm in thickness. This was evacuated.
We then placed pedicle screws first on the left, then on the right at the T11 and L1, placing 6.5mmx 45mm lenght at L1, and 5.5 x 35 mm length at T11, again obtaining serial x-rays. Instrumentation was Nuvasive.
This was followed by application of pedicle screws in the right, same size and same location, each being Nuvasive, 6.5x45 at L1, and 5.5x35 at T11. We then affixed 8.5cm rods, pursued distraction for realignment, and obtained x-ray demonstrating anatomic reduction of the T12 fracture with good pedicle screw and rod placement.
There wa a lordotic rod used for assitance and realignment.
A this point, the construct was tightened down and crosslink applied.
Lumbar puncture was pursued with the 22-gauge needle at the L2-L3 level. Then, .20 mg of intrathecal morphine admininstered.
We then decorticated over the lateral masses of T11-12, and L1, laid a combination of bone morphogenic protein, morselized allograft, and locally harvested bone diffused from T11-12 to L1 bilaterally.
A 10mm Jackson-Pratt drain was then placed in the epidural space through a seperate stab wound, and the wound was closed in multiple layers with #1 Vicryl suture in the paravertebral muscle fascia and subcutaneous, with Dermabond on skin. Op-site was applied. The wound was infiltrated with 0.5% Marcaine with epinephrine. The patient returned to the recovery room in stable condition.