Johns Hopkins neurosurgeon Louis Chang describes a surgical case involving minimally invasive laminectomy.
My name's Doctor Louis Chang. I'm a uh assistant professor of neurosurgery and I practice at Johns Hopkins, neurosurgery, Bethesda. So this is the intraoperative uh video of the surgery and this is through a microscope. The screen uh in the upper left shows where I am on the navigation screen. And what I just did was I thinned out the lamina and uh now a little bit deeper. Um and I'm removing the shelled out uh lamina and this is on the right side, the head is to the right and midline is uh up towards the screen. And uh after I've removed the uh thinned out lamina and some of the medial faces joint, you can see the uh ligament there. And now this maneuver is basically for me to uh look across the other side, I'm tilt tilting the tube down. So now I'm removing uh some of the residual um lamina on my side as well as uh some of the base of the spinous process after I thinned it out. Now I'm removing that uh uh thinned out bone and again, um the uh ligamentum flam is visible once I have the bone removed, then I find a safe plane uh to dissect the ligament uh off the dura. So I'm just working up towards the head and with that uh ball hook, I am able to lift that ligament up off the dura. Once I do that, then I could get that instrument in there and start removing the thickened ligaments and flav them piece meal. And you can see that the uh shiny, the shiny membrane underneath, that's the dura and within that dura uh are the nerves. Now, once I'm satisfied with removing the ligament to flav them on my side and in the midline, then the crucial part is to remove the ligament on the contralateral side. So now I'm reaching underneath the lamina all the way to the left side and I'm just carefully retracting the dura down just a little bit and protecting with this uh custom retractor that I made. Uh it's a uh flat suction retractor. Uh Now I could get that in underneath that ligament and carefully removed the thickened ligament under the left side, the lamina and face joint piece meal. And once I'm done with that, I could usually see a good decompression. Uh but I will also uh use an instrument to feel around and make sure that uh there is good decompression and I use that uh that uh in micro uh ball hook instrument and I could feel down towards the foot and there's nothing uh there's nothing compressive anymore. And just to double check if I'm using navigation, I could put the navigation pointer down and I could see on the screen that I am all the way underneath the cassette joint on the other side. And before I close, I put a little bit of steroid on top. And uh, that's basically it. Then I close with absorbable sutures, stereo ships on the skin. There's no need for a wound drain. And most of the time the patient goes on the same day, the patient is doing great. She went home the same day after surgery, she had very minimal surgical site pain and she noticed immediately improvement in the pain down her legs and she's able to walk further than she has before and she's becoming more active than before as well.
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