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hello this is doctor donald corenman and
we're going to view a video of a microdiscectomy of a lumbar
herniated disk
of the L5 S1
the lowest level in lumbar spine
here's a side view of the MRI and you can see the disc herniation
at the bottom level
this is top-down view
of the normal level
and then the next level you'll see has the herniation
on that right side that's pressing on the nerve root that's causing this patient
significant leg pain
our incision that we make as you can see is less than an inch long
these are some of the tools that we utilize
to do the surgery
and these tools you'll see during the video
look to be much larger
than normal simply because of the magnification that we use from the
microscope
we actually make our approach on the very side of the vertebra
between the bottom of the lamina
and here you can see a little laminotomy, a little bit of bone taken
away
this is the actual view of the lamina and this is the area that we're going to
start remove some of the bone
here's a burr
and the burr is taking off a little bit of bone and now we're going to
undermine that bone
and remove it so we have a little window that we can get into the spinal canal
here you can see
using this tool to remove the bone
and then what we'll do is we'll start remove the ligament and flavum
ligament and flavor asyou see here is vestigial ligament
that really doesn't help us much as far as day-to-day living
and it's
easily removed. here now you can see the nerve root
the nerve root being pressed up against us
and we're going to start to mobilize the nerve
the nerve tends to get stuck
from that disc herniation
and what we do
is we remove the nerve
and then we find the hole
where the herniation is coming out here you can see a small nerve hook
is getting into the defect where the herniation is
we start to mobilize as this material is very very adhesive
and once we mobilize it
then we can grab it and pull it out of the canal
once we pull it out of the canal as you can see
the nerve has substantial relief of pressure
here as we grab it we can pull the fragment out and here you can see how large
that fragment is
the nerve is now decompressed from removing the fragment
there's always a hole in the back of the disc
that hole is the egress point for this herniation
we reach through that hole and any loose fragments that are still within the disc
we remove
here you can see the nerve root is now free
and we can probe underneath the nerve root to make sure that the nerve has
total freedom it should be able to move
about a centimeter and here you can see it does
we use a nerve probe underneath the nerve to make sure there are no fragments that
are hiding and make sure that the nerve is fully free
that's what we're doing here we go across the canal also
that consists of the entire microdiscectomy
for the lumbar spine