mfournier
Networker
Hello:
Was wondering if someone can point out where the arthrodesis is within this op note?
Should this be 63047, 63048 X2
PROCEDURE PERFORMED:
1- Decompressive bilateral laminectomy L3 and L4 with medial facetectomy ( L2-3, L3-4, L4-5) with foraminotomy L3, L4 and L5.
2- Left L4-L5 facet cyst resection
3- Arthrodesis L2-L3, L3-L4, L4-L5 [none instrumented]
4-Insertion of subfascial drain
OPERATIVE TECHNIQUE
The patient was prepped and draped in the standard sterile fashion. Local anesthetic was infiltrated along the line of the skin incision which was subsequently opened sharply with a # 10 scalpel blade. Further dissection was carried down in the midline until the level of supraspinous ligament utilizing bipolar forceps and Bovie electrocautery for hemostasis. The musculature was elevated subperiosteally on the with Bovie electrocautery and Cobb elevator. Hemostasis was achieved. Self-retaining retractors were then inserted.The C-arm fluoroscopy was draped and brought in to the operative field and the L2-3and L4-L5 were positively identified. The posterior spinous processes of L3 and L4 were cut off with heavy bone Leksell rongeurs. Utilizing Pneumatic drill ,Leksell rongeurs and up-currets, Bilateral lamina of L3 and L4 were removed. Utilizing sharp dissection and #3 and #4 Kerrisons the ligamentum flavum was freed from the superior border of L5 and the inferior border of L2 preserving the dura intact.At the left L4-5 facet joint, facet cyst was encountered and removed. The cyst wall was sent to pathology.
At this point, the dura was noted to be well decompressed. All lateral recesses and the neuroforamina were noted to be well decompressed as well. The space from L2 through L5 was again confirmed utilizing fluoroscopy.The transverse process of L2, L3, L4 and L5 bilaterally were exposed and decorticated. Hemostasis achieved.Autograft and allograft [Viviegn] were mixed together and places over the transverse processes bilaterally L2-L5.
A medium size hemovac drain was placed and brought out through a separate stab incision. Vancomycin powder was applied.The wound was copiously irrigated. The fascia was subsequently closed utilizing interrupted 0 (Vicryl).Vancomycin powder applied above the fascia. Local anesthetic was given around the area and subcutaneous tissue was approximated with 2-0 Vicryl, after the wound had been copiously irrigated with antibiotic saline irrigation. The skin was then approximated with 4-0 Monocryl. The incision was dressed in a clean dry dressing.
I really appreciated any clarification.
Thanks you
Was wondering if someone can point out where the arthrodesis is within this op note?
Should this be 63047, 63048 X2
PROCEDURE PERFORMED:
1- Decompressive bilateral laminectomy L3 and L4 with medial facetectomy ( L2-3, L3-4, L4-5) with foraminotomy L3, L4 and L5.
2- Left L4-L5 facet cyst resection
3- Arthrodesis L2-L3, L3-L4, L4-L5 [none instrumented]
4-Insertion of subfascial drain
OPERATIVE TECHNIQUE
The patient was prepped and draped in the standard sterile fashion. Local anesthetic was infiltrated along the line of the skin incision which was subsequently opened sharply with a # 10 scalpel blade. Further dissection was carried down in the midline until the level of supraspinous ligament utilizing bipolar forceps and Bovie electrocautery for hemostasis. The musculature was elevated subperiosteally on the with Bovie electrocautery and Cobb elevator. Hemostasis was achieved. Self-retaining retractors were then inserted.The C-arm fluoroscopy was draped and brought in to the operative field and the L2-3and L4-L5 were positively identified. The posterior spinous processes of L3 and L4 were cut off with heavy bone Leksell rongeurs. Utilizing Pneumatic drill ,Leksell rongeurs and up-currets, Bilateral lamina of L3 and L4 were removed. Utilizing sharp dissection and #3 and #4 Kerrisons the ligamentum flavum was freed from the superior border of L5 and the inferior border of L2 preserving the dura intact.At the left L4-5 facet joint, facet cyst was encountered and removed. The cyst wall was sent to pathology.
At this point, the dura was noted to be well decompressed. All lateral recesses and the neuroforamina were noted to be well decompressed as well. The space from L2 through L5 was again confirmed utilizing fluoroscopy.The transverse process of L2, L3, L4 and L5 bilaterally were exposed and decorticated. Hemostasis achieved.Autograft and allograft [Viviegn] were mixed together and places over the transverse processes bilaterally L2-L5.
A medium size hemovac drain was placed and brought out through a separate stab incision. Vancomycin powder was applied.The wound was copiously irrigated. The fascia was subsequently closed utilizing interrupted 0 (Vicryl).Vancomycin powder applied above the fascia. Local anesthetic was given around the area and subcutaneous tissue was approximated with 2-0 Vicryl, after the wound had been copiously irrigated with antibiotic saline irrigation. The skin was then approximated with 4-0 Monocryl. The incision was dressed in a clean dry dressing.
I really appreciated any clarification.
Thanks you