Neurosurgery Coding
in Seconds, Not Hours

OPERATIVE NOTE PATIENT: [NAME_1] DATE: [DATE_1] SURGEON: [NAME_2] PREOPERATIVE DIAGNOSIS: Adult degenerative scoliosis with severe sagittal imbalance, flat back syndrome, and severe lumbar spinal stenosis with neurogenic claudication. POSTOPERATIVE DIAGNOSIS: Same PROCEDURE: 1. Posterior thoracic laminectomy T10, T11, T12 2. Posterior lumbar laminectomy L1, L2, L3 3. Smith-Petersen osteotomies (Grade 2) at L2-3, L3-4, and L4-5 4. Transforaminal lumbar interbody fusion (TLIF) at L4-5 and L5-S1 bilaterally 5. Posterior segmental instrumentation T10 to S1 with pelvic fixation (bilateral iliac screws) 6. Arthrodesis for spinal deformity, 9 vertebral segments 7. Application of local autograft, structural allograft, and bone morphogenetic protein (rhBMP-2) 8. Application of stereotactic computer-assisted navigation (O-arm/Stealth) 9. Intraoperative neuromonitoring (SSEP, MEP, EMG) ANESTHESIA: General endotracheal EBL: 1850 mL IMPLANTS: DePuy Synthes EXPEDIUM 5.5mm System (T10-Iliac), 2 Concorde PEEK interbody cages (L4-5, L5-S1), Infuse rhBMP-2. INDICATIONS: The patient is a [AGE_1]-year-old with severe adult degenerative scoliosis, significant positive sagittal imbalance, and refractory neurogenic claudication. Previous conservative therapy failed. Extensive realignment and decompression are required. DESCRIPTION OF PROCEDURE: The patient was brought to the OR, intubated, and positioned prone on an OSI Jackson frame. A midline incision from T9 to the sacrum was made. Subperiosteal dissection exposed the posterior elements from T10 to the pelvis. The O-arm was brought in for intraoperative CT spin and registration with the Stealth navigation system. Navigation was used continuously for the placement of all pedicle and pelvic screws. Pedicle screws were placed bilaterally from T10 through S1, and bilateral iliac screws were placed into the pelvis using navigated guidance. A total of 18 pedicle screws and 2 iliac screws were placed. Position was verified with a second O-arm spin. Extensive wide laminectomies were performed from T10 down to L3. The ligamentum flavum was hypertrophied and was removed en bloc. Bilateral foraminotomies were performed at all lumbar levels to free the exiting nerve roots. To restore sagittal balance, multi-level posterior column osteotomies (Smith-Petersen) were performed at L2-3, L3-4, and L4-5. The facets and pars interarticularis were completely resected bilaterally at these levels, providing significant mobility for lordosis restoration. An operating microscope was brought into the field. Bilateral transforaminal lumbar interbody fusions (TLIF) were performed at L4-5 and L5-S1. The disc material was thoroughly evacuated. Endplates were decorticated. PEEK cages packed with local autograft and Infuse (rhBMP-2) were impacted into the L4-5 and L5-S1 disc spaces bilaterally. Dual 5.5mm cobalt-chrome rods were contoured with significant lumbar lordosis and secured. Compression was applied across the osteotomy sites to close the osteotomies and restore sagittal balance. Set screws were final tightened. The decorticated gutters and pars were packed with morcellized allograft bone mixed with local autogenous bone harvested from the laminectomies. A subfascial drain and a subcutaneous drain were placed. The fascia was closed watertight with 0-PDS in a figure-of-eight fashion. Subcutaneous tissues were closed with 2-0 Vicryl, and skin was closed with staples. Neuromonitoring: SSEP, MEP, and triggered EMG were monitored constantly. Baseline potentials were maintained throughout. Assistant: Co-surgeon Dr. [NAME_3] (Orthopedics) was present and actively participated in the exposure, osteotomies, instrumentation, and rod contouring for the entirety of the procedure. COMPLICATIONS: None. Patient received 2 units PRBCs intraoperatively.