COMPREHENSIVE PAIN MANAGEMENT, PC

PATIENT:                                                     MR#                        

ADM DATE:                                                         DIS DATE:                 06/16/17                        

ACCT #:                                                 PATIENT LOC:                        

REPORT #            0619-0110                                            PATIENT TYPE:                                  

DOB:                  

 

SURGERY DATE: 06/16/2017

 

PREOPERATIVE DIAGNOSIS:  Compression fracture, L1.

 

POSTOPERATIVE DIAGNOSIS:  Compression fracture, L1.

 

PROCEDURE:  Balloon kyphoplasty at L1 vertebra and bone biopsy.

 

ANESTHESIA:  General with local.

 

COMPLICATIONS:  None.

 

BLOOD LOSS:  Minimal.

 

The risk, benefit and alternatives including no treatment were discussed with the patient.  The patient appeared to understand and consent form was signed.

 

DESCRIPTION OF PROCEDURE:  The patient was brought into OR per nurse.  The patient was placed in prone position.  The anesthesia was administered by anesthesiologist.  The back was prepared with Betadine x3 and then draped sterilely.  The C-arm x-ray was also draped sterilely.  The C-arm x-ray was then brought into the position and L1 pedicles were identified and marked with a skin marker.  In view of the collapse of L1, a transpedicular approach to the vertebral body was appreciated.  An 11-gauge needle was advanced through the L1 pedicle to the junction of a pedicle and vertebral body on the right side.  Position was confirmed on the AP and the lateral view.  Following satisfactory placement of the needle, the stylet was removed.  A guide pin was inserted through the 11-gauge needle to a point 3 mm from the anterior cortex.  An AP and lateral imaging was taken to verify the position and trajectory.  Alongside of the guide pin, a 1 cm paramedian incision was made.  The needle was then removed and leave the guide pin in place.  The osteo introducer was placed over the guide pin and advanced through the pedicle.  Once it was at the junction of the pedicle and the vertebral body, a lateral imaging was taken to ensure that the cannula was positioned approximately 1 cm past the vertebral body wall.  Through the cannula, a drill was advanced into vertebral body under fluoroscopic guidance towards the anterior cortex creating a channel.  The anterior cortex was probed with the guide pin to ensure no perforation in the anterior cortex.  After completing the entry into the vertebral body, a 15 mm inflatable bone tamp was inserted through the cannula and advanced under fluoroscopic guidance into the vertebral body near the anterior cortex.  The radiopaque marker and the bone tamp were identified, use AP and lateral view of C-arm x-ray.  The above sequence of instrument placement was then repeated on the left side of the L1 vertebral body.  Once both bone tamps were in position, they were inflated to 0.5 mL and 50 psi.  Expansion of the bone tamps was done sequentially in increments of 0.25-0.5 mL of contrast with careful attention being paid to the inflation pressure and balloon position.  The inflation was monitored with AP and lateral view of the C-arm x-ray.  Final balloon volume was about 3 mL bilaterally.  There is no breach of the lateral wall or anterior cortex of the vertebral body.  Direct reduction of the fracture was achieved under fluoroscopic imaging and the use of bone void fillers.  Internal fixation was achieved through low pressure injection of Kyphon HV-R bone cement.  The cavity was filled with a total volume of about 3 mL bilaterally.  Once the bone cement had hardened, the cannula was then removed.  The incision was then closed with sutures.  The patient was kept in position for approximately 10 minutes post cement injection.  She was then turned supine, monitored briefly and the patient was then transferred to ICU for close monitoring.  The patient was then discharged home in stable condition.  There were no complications for the procedure.

 

 

 

 

__________________________________________

PETER ZHENG MD

 

 

PZ/HN

D: 07/16/2017 23:30:41

T: 07/24/2017 14:50:05

Job ID: 055518

 

 

 

 

_________________________________________________

Signed By:     

 

 

 

 

 

Signed By:     

 

 

Dictated By:  ZHENG, PETER S MD

DD/DT:  07/16/17 2330

TD/TT:  07/24/17

Report #:  0619-0110

 

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