Baylor Medical Center Operative Report
This operative note is a report of the surgery performed on Michael Stuart by Dr. Ioannis Alexander Avramis on January 4, 2024, at Baylor Scott and White University Medical Center in Dallas Texas.
Here’s an explanation of the key components and medical terms:
- Lumbar Kyphoscoliosis, L1-L3 Nonunion, and Loose Instrumentation, Post L1-S1 Laminectomy and Sagittal Imbalance: These are the preoperative and postoperative diagnoses.
- Procedure Performed: The surgery was conducted in two stages to address the spinal issues:
- Stage I: Involved anterior (front) lumbar interbody fusion (fusing the front part of the lumbar spine) with cage insertion (implanting a device to help maintain spine alignment), stabilization, and osteotomy (bone cutting) at levels L3 to S1.
- Stage II: Involved posterior (back) spinal fusion from T10 (thoracic) to S1 (sacral) with spinal instrumentation (inserting rods and screws to stabilize the spine), bilateral iliac fixation (stabilizing the pelvis), osteotomies at L2-L3 and L4-L5 (more bone cutting for alignment correction), and other corrective procedures.
The operative note mentions the patient’s previous surgical history as part of the context for the current surgery. Here’s what it says about the previous procedure:
- Laminectomy from L1-S1: This indicates that the patient, Michael, had previously undergone a laminectomy – a surgical procedure involving the removal of part of the vertebral bone called the lamina. This procedure was performed on a significant portion of the lower spine, spanning from the first lumbar vertebra (L1) to the first sacral vertebra (S1). Laminectomy is typically done to relieve pressure on the spinal cord or nerves.
- Attempted Fusion from L1-L3 with Floridly Loose Screws: The patient also had a spinal fusion surgery that attempted to fuse the vertebrae from L1 to L3. However, this procedure was not entirely successful, as indicated by the presence of “floridly loose screws.” This means that the screws intended to hold the vertebrae together and promote bone fusion had become loose. Loose screws can compromise the stability of the spine and potentially cause pain or further complications.
- Breached Screws into the Canal: It is mentioned that the screws were breached into the canal, particularly on the left at L1 and L3. This suggests that the screws had improperly penetrated into the spinal canal, where the spinal cord and nerves are located. This misplacement could lead to nerve irritation or damage.
- Symptoms and Decision for Further Surgery: The patient experienced classic symptoms of back pain and sagittal imbalance, which likely resulted from the complications of the previous surgeries. Faced with these issues and having exhausted nonsurgical treatment options, the patient opted to proceed with the current surgical intervention.
The previous surgery resulted in complications leading to back pain and spinal imbalance. These complications necessitated the current, more complex surgical intervention.
Operative Note
Signed by: Dr. Ioannis A. Avramis
Date: January 5, 2024
Institution: Baylor Scott and White, Baylor University Medical Center
Date of Service
January 4, 2024
Preoperative Diagnoses
- Lumbar kyphoscoliosis with L1-L3 nonunion and loose instrumentation, status post L1-S1 laminectomy and sagittal imbalance.
Postoperative Diagnoses
- Lumbar kyphoscoliosis with L1-L3 nonunion and loose instrumentation, status post L1-S1 laminectomy and sagittal imbalance.
Procedures Performed
- Stage I: Anterior lumbar interbody fusion with cage insertion, stabilizing instrumentation and osteotomy for deformity correction L3-L4, L4-L5, and L5-S1.
- Stage II: Posterior spinal fusion T10-S1, posterior spinal instrumentation T10-S1, bilateral iliac fixation, Smith-Petersen osteotomies L2-L3 and L4-L5, left side transforaminal lumbar interbody fusion with cage insertion L2-L3, removal of instrumentation L1-L3, exploration of fusion L1-L3, harvest of local autograft, use of allograft.
Surgical Team
- Surgeon: Ioannis A. Avramis, MD
- Co-Surgeon (Stage I): Donald Reed, MD
- Assistant: James Rizkalla, MD and Kassidy Rico, PA-C
- Anesthesiologist: Wiley, MD
Anesthesia
- General endotracheal
Estimated Blood Loss
- 700 mL
Complications
- None known
Monitoring
- No changes including motor evoked potentials.
Drains
- One deep posterior.
Implants
- DePuy Expedium.
Disposition
- The patient was transferred to ICU in stable condition.
Indications for Procedure
Michael, a 64-year-old male with a history of previous lumbar surgeries leading to laminectomy from L1-S1 and attempted fusion from L1-L3 with floridly loose screws and sagittal imbalance, presented with back pain. After exhausting nonsurgical treatments, he consented to surgery.
Description of Procedure
Michael was brought to the operating room, anesthetized, and placed supine. The procedure began with anterior lumbar interbody fusion from L3-S1, followed by posterior spinal fusion from T10-S1. Detailed steps included osteotomy for deformity correction, cage insertion, and spinal instrumentation. Dr. Reed’s dictation covers exposure and closure details. The posterior part involved pedicle screw placement, bilateral iliac fixation, and osteotomies at L2-L3 and L4-L5. The procedure aimed to correct lumbar kyphoscoliosis and restore spinal alignment, concluded with wound closure and transfer to ICU.
Postoperative Plan
Michael will receive IV antibiotics, pain management, and physical therapy. He is to wear a TLSO brace when out of bed, except for bathroom privileges, and have SCDs for DVT prophylaxis.
Acknowledgement to Dr. James Rizkalla, MD and Kassidy Rico, PA-C for their critical surgical assistance.