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From this point the microscope is used for visualization. Any remaining soft tissue can be removed with electrocautery. The exposure includes the base of the spinous processes, lamina and facet joint. Additional rostral and caudal exposure can be achieved by changing the angle of the speculum. A high speed drill and Kerrison rongeurs are used to create the laminotomy, foramenotomy and facetectomy (if necessary).
Angling the speculum up and down allows the surgeon to decompress both the exiting and traversing nerve roots (two intervals). Angling the speculum medially and undercutting the lamina/spinous process allows the surgeon to achieve a central decompression and even decompress the nerve roots on the opposite side. Closure – The fascia and subcutaneous layers are closed with absorbable suture. The skin is sealed with tissue glue, which serves the dual purpose of skin approximation and wound dressing.
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Jackson, MS 39216