John H Shin, MD Physician Neurosurgery Spine Op Note Signed Date of Service: 3/29/2019 9:09 AM Procedure: POSTERIOR CERVICAL FUSION LEVELS (C3-T1) WITH RIGHT SIDE ILIAC GRAFT BONE GRAFT HARVEST Case Time: 3/29/2019 9:09 AM Surgeon: John H Shin, MD
Full Operative Note Patient Name: Andrew C Brengle Date of Surgery: 3/29/2019 Pre-Op Diagnosis Codes: * Cervical spondylosis with myelopathy [M47.12] Post-Op Diagnosis Codes: * Cervical spondylosis with myelopathy [M47.12] Procedure(s): POSTERIOR CERVICAL DECOMPRESSION AND FUSION LEVELS (C3-T1) WITH RIGHT SIDE ILIAC GRAFT BONE GRAFT HARVEST Surgeon(s): John H Shin, MD Resident: Christopher A Alvarez-Breckenridge, MD, PhD Anesthesia Attending: Mazen A Maktabi, MBBCh
Anesthesia Resident: Cliodhna M Ashe, BMBS Anesthesia Type: General Implants: Depuy Description of Procedure: The patient was brought to the operating room. IV access was obtained. The patient was intubated and positioned prone onto the Jackson table with all pressure points padded. I personally verified his positioning. The head was secured in the Mayfield head holder. An x-ray was performed. The patient was prepped and draped. Antibiotics were secured in the Mayfield head holder. An x-ray was performed. The patient was prepped and draped. Antibiotics were administered. A timeout was performed with the nursing staff and anesthesia. A midline incision was made and exposure was performed identifying C3-T1. Deep retractors were placed and another localizing x-ray was performed. Starting points for the instrumentation at the C3, C4, C5, C6 levels was performed using a high-speed drill. The Stryker cordless drill was then used to cannulate the lateral masses of C3, C4, C5, and C6. The bilateral T1 pedicles were cannulated using the high-speed drill as well as a gearshift probe. At the T1 level, 5.0 x 30 mm screws were placed bilaterally with excellent purchase. Troughs were then drilled at the C3, C4, C5, C6, C7 levels. The lamina and the spinous processes were resected en bloc. Hypertrophy ligamentum was also resected. Bilateral foraminotomies were performed at C3-4, C4-5, C5-6, and C6-7, and C7-T1. Kerrison instruments were used to widen the lamina form foraminotomies at each of these levels after drilling the medial facets. The nerve roots were identified at each level and followed with a blunt nerve hook instrument. 14 mm screws were then placed into the lateral masses of C3, C4, C5, and C6. At the C7 level, bilateral 18 mm pedicle screws were placed into the C7 pedicles under direct visualization after cannulating the pedicles with an 18 mm drill bit. Lordotic rods were configured and slight compression was applied, maximizing the patient's lordosis. Final set caps were applied. Final torque was applied. A separate incision was made over the right posterior superior iliac spine. The outer table of the iliac crest was identified. Osteotomes were used to resect the outer cortical bone of the iliac crest and various gouges were used to obtain morcellized iliac crest. This is separate skin and fascial opening was then closed after sufficient volume of iliac crest graft was obtained. The morselized autograft from the iliac crest was mixed with morselized autograft from the decompression and this was packed posterolaterally between C3-4, C4-5, C5-6, C6-7, and C7-T1 for posterolateral arthrodesis. Multilayered closure was then performed over a Hemovac drain. Dressing was applied. The patient was extubated and taken to recovery for further postoperative monitoring. Estimated Blood Loss: 500 mL Attending attestation: I performed the surgery and all critical portions. John H. Shin, MD