Teaching Video: Efficacy and Risks of Decompression
This video show the efficacy and risks of decompression. The 82 year old orthopedic surgeon (patient) had residual leg and back pain following a translaminar decompression for stenosis. In this video, endoscopic findings are illustrated and the residual lateral stenosis is common. The residual pain is suspected to be from an osteophyte irritating the exiting nerve which is confirmed by diagnostic and therapeutic TFESI. Spine surgeons should suspect this case when translaminar decompression fails.
M. Dohm, who had training in YESS endoscopic surgery, diagnosed the cause and provided temporary relief with TFESI at L4-L5. Dr. Dohm referred patient and successful endoscopic decompression anticipated.
The patient had 5-8 hours of no pain, then the next morning, severe back pain and spasms developed.
Rare Hemotoma Pitfall
A hematoma was discovered at the TP of L5 and was aspirated from the rhizotomy portal. This has only occurred twice, since bleeding is allowed through skim incision and there is little dead space. The bleeding will usually escape through the incision and stops because of no dead space.
Risk of Osteophyte Decortication
This complication is rare and has only occurred one other time. Aspirate and anesthetize the surgical portal(s) when there is unanticipated post-op pain.
In this patient, the extensive reaming and burring of bone probably caused the hematoma. If there is concern, use post-op hemovac. Allow bleeding from the incision in RR until bleeding stops before discharge.