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LUMBAR LAMINECTOMY AND DISCECTOMY

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LUMBAR LAMINECTOMY AND DISCECTOMY

  1. 1. 31 ©2005 Medtronic Sofamor Danek LUMBAR LAMINECTOMY AND DISCECTOMY Lumbar – Relating to the loins or the section of the back and sides between the ribs and the pelvis. In the spinal column, the last five vertebrae (from superior to inferior, L1-L5) Laminectomy – Surgical removal of part or all of the posterior vertebral elements Discectomy – The removal of all or part of an intervertebral disc Basic Anatomical Landmarks: Posterior View Lumbar Spine Transverse Process Spinous Process Facet Joint Lamina L1 L2 L3 L4 L5 Sacrum
  2. 2. 32 ©2005 Medtronic Sofamor Danek LUMBAR LAMINECTOMY AND DISCECTOMY Basic Anatomical Landmarks: Lumbar Spine Lumbar Spine Posterior View Vertebral Body Lateral View Vertebral Body, Endplate and Disc Anterior View Lumbar Vertebrae Superior View
  3. 3. 33 ©2005 Medtronic Sofamor Danek LUMBAR LAMINECTOMY AND DISCECTOMY Basic Anatomical Landmarks The posterior elements of the spine lie under these muscles. Deep Muscles of the BackSuperficial and Intermediate Layers of the Back
  4. 4. 34 ©2005 Medtronic Sofamor Danek LUMBAR LAMINECTOMY AND DISCECTOMY Approach/Patient Positioning The patient is positioned in the prone position with abdomen free and spine flexed to aid in Intraoperative exposure. Anesthesia Station Microscope Fluoro Fluoro Monitors
  5. 5. 35 ©2005 Medtronic Sofamor Danek LUMBAR LAMINECTOMY AND DISCECTOMY Techniques 1. Standard Microdiscectomy 2. Transmuscular Microdiscectomy - (Minimally Invasive) 3. Intermuscular Discectomy Essentially all three of these procedures are intended to serve the same purpose: to remove all or part of the intervertebral disc. The differentiating factor between the procedures is the approach taken to create an exposure of the disc to be excised. All three involve a skin incision, resection of the subcutaneous tissue (fat), fascia, muscle and a laminectomy.
  6. 6. 36 ©2005 Medtronic Sofamor Danek LUMBAR LAMINECTOMY AND DISCECTOMY Technique: Standard Microdiscectomy The removal of all or part of an intervertebral disc. This technique involves stripping the muscles from the spinous process through a small skin incision followed by a laminectomy and then discectomy. Disc Skin Subcutaneous Tissue Fascia (thin membrane surrounding each muscle) Muscle Spinous Process Lamina (Removal of this portion of bone is a laminectomy) Fascia
  7. 7. 37 ©2005 Medtronic Sofamor Danek LUMBAR LAMINECTOMY AND DISCECTOMY Technique: Transmuscular (Muscle Splitting) The skin incision is made slightly off midline. The intramuscular approach enables the surgeon to access the spine in a less invasive fashion than a midline incision. It’s considered minimally invasive because it preserves the posterior musculature of the spine. Muscle still attached to the Spinous Process Incision Site Spinous Process Incision Created for a Transmuscular Approach
  8. 8. 38 ©2005 Medtronic Sofamor Danek LUMBAR LAMINECTOMY AND DISCECTOMY Technique: Transmuscular (Muscle Splitting) This approach utilizes a technique of muscle splitting to access the spine. Essentially, a needle is inserted at the operative site and a series of tubular dilators are advanced over it to create an exposure large enough to perform the procedure through the appropriate size tube. 20-Gauge Needle Tubular Dilators
  9. 9. 39 ©2005 Medtronic Sofamor Danek LUMBAR LAMINECTOMY AND DISCECTOMY Technique: Transmuscular Discectomy Discectomy Performed through a Tube
  10. 10. 40 ©2005 Medtronic Sofamor Danek LUMBAR LAMINECTOMY AND DISCECTOMY Technique: Intermuscular/Paramedian Discectomy Intermuscular Microdiscectomy – The removal of all or part of an intervertebral disc through a Wiltse incision Wiltse Incision – Approach in which the surgeon dissects between the fascial planes of the longisimus and multifidus muscles

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