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• Back pain
• Pressure on the lumbosacral nerve roots
• Weakness
• Bowel dysfunction
• Bladder dysfunction
• Herniated disc
• Osteoporosis
• Osteoarthritis


• Pulmonary insufficiency
• Cardiac insufficiency
• Mitral valve insufficiency
• Aortic valve insufficiency
• Cardiovascular insufficiency
• Old age
• Hypertension
• Dehydration
• Malnutrition
• Diabetes
• Hypothyroidism
• Bleeding disorder
• Allergies to medication
• Allergies to anesthesia


• Blood tests
• Urine tests
• X-ray chest
• X-ray spine
• CT scan
• Myelogram
• Aspirin was stopped before the procedure
• Patient was on fasting for ____hrs before procedure
• Part was prepared and draped in sterile fashion


• General anesthesia
• Local anesthesia


• The Prone Position

• Lateral Decubitus Position



• The back was shaved, scrubbed with Betadine scrub, rinsed with
alcohol, and prepped with DuraPrep, and draped in the usual
sterile fashion with Ioban drape being used.
• A midline skin incision was made. Dissection was carried down
through the subcutaneous tissue.
• The lumbosacral fascia was split to the left of the spinous
• A small amount of bone and ligament from the back of the spine
was removed (laminectomy was done)
• Dura and nerve root were identified and protected with nerve
root retractor
• The herniated disc fragment was removed
• The disc has been cleaned out from the area around the nerves
• Check was made for CSF leakage, and no evidence of significant
epidural bleeding was present.
• The wound was irrigated with antibiotic solution.
• Twenty milligrams of Depo-Medrol was placed over the dura and
nerve root.
• A free fat graft from the subcutaneous tissue was then placed
over the dura.
• Closure was obtained with the lumbosacral fascia being
reapproximated with #1, running, and Vicryl suture.
• Subcutaneous closure was obtained in layers with 2-0, running,
Vicryl suture.
• Skin closure was obtained with 3-0 Vicryl subcuticular suture.
• Proxi-Strips and sterile dressing was applied.
• The skin had been infiltrated with 8 mL of 0.5% Marcaine with


• Part was prepared and draped

• Local anesthesia was given at the site of surgery
• Patient was in the prone or lateral decubitus position
• The disc space was identified with the help of a C-arm
• Disc margins were made clear by craniocaudal movement of the
fluoro tube.
• At this time, the fluoro tube was rotated obliquely to bring the
superior articular process to the mid line.
• An 18-gauge 7-in needle was introduced immediately anterior to
the superior articular process and superior to the transverse
process via a triangular safe zone.
• The needle was advanced in 1- to 2-cm increments in a "stop
and look and go" process, to allow a change of course if it is not
directed properly.
• The needle tip was at the center of the disc upon completion.
• The rubbery texture of the annulus was easily felted with the tip
of the 18-gauge needle.

Laser application
• The needle was reached the annulus, advanced it through the
annulus and into the nucleus pulposus for a distance of
approximately 1 cm.
• The fiber was marked to prevent penetration of the tip more
than 1 cm beyond the end of the needle.
• The laser was applied as energy levels of ____ W, with __pulses,
until ___________ J was delivered for ______seconds
• Fluoroscopic images were taken
• The needle was removed slowly


• Patient was shifted to the intensive care unit

• Blood pressure, temperature, pulse rate was monitored




• Take antibiotics as prescribed

• Take pain medication as prescribed
• Must lie on prone position
• Sleep on a firm mattress
• Avoid bending at the waist
• Avoid lifting heavy weights
• Avoid sitting for long time
• Use a reclined chair
• Avoid bending, twisting, lifting heavy objects
• Begin exercise after two weeks
• Keep the dressing clean and dry


• Infection
• Bleeding
• Injury to the nerves
• Injury to the blood vessels
• Paralysis of leg
• Bladder weakness
• Discitis
• Subchondral marrow abnormalities
• Persistent of pain
• Deep vein thrombosis