Incision: A midline longitudinal
incision centered over the vertebrae intended to be exposed is made. The length of incision can be increased depending on
the number of vertebrae that need to be exposed.
Adrenaline infiltration: Depends
on surgeon’s preference, as the duration of action is limited. A 1: 500,000 epinephrine solution in saline can be injected
into subcutaneous tissue.
The incision is carried down
to the spinous process.
Para spinal muscles are then
stripped subperiosteally using a cobbs elevator. The elevator is directed with cutting edge dorsally so as to go under the
bulbous tip of spine process. The cutting edge may then be turned ventrally to clear the tissue from the lamina as far laterally
This side is then packed with
roller gauze to control bleeding.
Similar steps are then repeated
on other side and that side too is packed with roller gauze.
After few minutes the packing
is removed and the area is irrigated with saline solution to remove all the blood clots, and two self-retaining mastoid retractors
are put at both ends of the wound.
Cut the intervening soft tissue
between the spinous process using a cautery.
The level can now be reconfirmed
either by sacral sounding or taking an intraoperative marker X ray.
Deep Surgical dissection:
The ligamentum flavum has two layers superficial and deep. The lateral edge of the superficial ligament flavum is cut with
a knife. The superficial portion in the interlaminar space is removed laterally to medially using a curet. A forward can be
used to make laminotomy in the superior lamina. An incision made medially in the ligametum flavum where it is thinnest exposes
the epidural fat and blue white dura. A small cottoniod can be inserted under the ligamentum flavum laterally, over which
the ligamentum flavum can be cut from medial to lateral on both sides.
A blunt dissection lateral
to dura is continued down the floor of spinal canal, retracting the dura and nerve root medially.
Post laminectomy kyphosis.
Neural root damage.
Cerebrospinal fluid leakage