Radiofrequency Rhizotomy

Radiofrequency Rhizotomy

Diagnosis:  ___________________

The patient presents today for radio frequency rhizotomy of the medial branch nerves of the cervical facet joints at the C4-C5, C5-C6, and C6-C7 levels on the right/left side.

Procedure:  The patient/family member has been informed of the risks and benefits of the planned procedure.  Procedure – radiofrequency rhizotomy of the medial branch nerves of the cervical facet joints at the C4-C5, C5-C6, and C6-C7  levels on the  right/left side

Informed consent was obtained.  In the fluoroscopy room, the patient was placed in a prone position and pillows are placed under the chest to allow the cervical spine to be moderately flexed without discomfort.  The patient’s forehead was allowed to rest on a folded blanket on a small pillow.  An AP view of the cervical spine was obtained.  The fluoroscopy beam was rotated to view the center of the neural arch.  The target level was then identified.  The skin was prepped and draped in a sterile manner.  Under fluoroscopic the skin and deeper tissues were numbed with 0.5% lidocaine.  Under fluoroscopic guidance a 2-inch, 20 gauge radiofrequency probe was guided to contact the centroid of the neural arch.  The needle position was confirmed on AP and lateral views.  Initially sensory stimulation was done, and then motor stimulation was done.  Contractions of the multifida were noted.  No extremity contractions noted.  The impedance at each of the levels was noted to be  right/left at the C4-C5 level,  right/left at the C5-C6 level,  right/left at the C6-C7 level.  Then using the radiofrequency rhizotomy technique, the medial branch nerves at each of these levels was lesioned.  The duration of the lesioning was 120 seconds and the temperature was maintained at 42 degrees.  The patient tolerated the procedure well.  Complications none.

Caudal Epidural Steroid Injection

Procedure Note – Caudal Epidural Steroid Injection

PATIENT:  ____________________

PHYSICIAN:  Physician Name

DIAGNOSIS:  _______________

DATE OF PROCEDURE:  ____________

PROCEDURE:  Caudal Epidural

The patient/family member has been informed of the risks and the benefits of the planned procedure.

In the fluoroscopy room the patient was placed in a prone position and the skin over the lumbosacral spine including the gluteal cleft was prepped and draped in a sterile manner.  The sacral curve was identified under fluoroscopy.  The sacral cornu was identified by palpation.  The skin and deeper tissues were numbed with 0.5% lidocaine.  The caudal epidural space was accessed with a 22 G 3½ inch spinal needle via the sacral cornu.  Loss of resistance was obtained.  2 cc of Omnipaque was injected.  The dye was seen to spread along the sacral epidural space.  Then 18 cc of 1/8 bupivacaine and 80 mg of methylprednisolone was injected.

Patient tolerated the procedure very well.

Complications:  None.

Full discharge instructions were given to the patient.  The patient was discharged in a stable condition.

__________

Physician Name

EXCISION OF LIPOMA

EXCISION OF LIPOMA

PREOPERATIVE DIAGNOSIS:  Lipoma.

POSTOPERATIVE DIAGNOSIS:  Lipoma.

PROCEDURE PERFORMED:  Excision of lipoma.

ANESTHESIA:  Local anesthesia.

COMPLICATIONS:  None.

INDICATIONS:  I recommended to the patient to undergo the above-named procedure.  Procedure, purpose, risks, expected benefits, potential complications, alternatives forms of therapy were discussed with the patient, and the patient was agreeable to surgery.

DESCRIPTION OF PROCEDURE:  The patient was identified and an informed consent was obtained.  A marking pen was used to draw an outline of the lipoma and a planned skin excision on the skin surface.  The outline of the tumor helped to delineate margins, which was obscured after administration of the anesthetic.  Excision of some skin helped to eliminate redundancy at closure.  The skin was then cleansed with povidone iodine/chlorhexidine solution, making sure to avoid wiping away the skin markings.  The area was draped with sterile towels.  Local anesthesia was administered with 1/2 percent lidocaine with epinephrine, as a field block.  A 3-mm to 4-mm incision was made over the lipoma.  The incisions were configured like a fusiform excision following the skin tension lines and were smaller than the underlying tumor.  The central island of skin to be excised was grasped with a hemostat/Allis clamp, which was used to provide traction for the removal of the tumor.  Dissection was then performed beneath the subcutaneous fat to the tumor.  Tissue cutting was performed under direct visualization using a #15 scalpel/scissors around the lipoma.  Care was taken to avoid nerves/blood vessels that may lie just beneath the tumor.  Once a portion of lipoma has been dissected from the surrounding tissue, hemostats/clamps were attached to the tumor to provide traction for removal of the remainder of the growth.  Once it was freed, the lipoma was delivered as a whole.  The surrounding tissue in the hole was palpated to ensure complete removal of the tumor.  Adequate hemostasis was achieved following the removal of the lipoma using hemostats/suture ligation.  The dead space was closed beneath the skin using buried, interrupted 3-0/4-0 Vicryl sutures.  Occasionally drains have been placed to prevent fluid accumulation.  The skin was then closed with interrupted 4-0/5-0 nylon sutures.  A pressure dressing was placed to reduce the incidence of hematoma formation.  The patient is given routine wound care instructions, and the wound is checked in two to seven days.  The sutures are removed after seven to 21 days, depending on the body location.  Specimens were submitted for histologic analysis.

Lumbar Epidural Injection

Lumbar Epidural Injection Procedure

PATIENT:  ____________________

PHYSICIAN: 

DIAGNOSIS:  Lumbar Radiculopathy

DATE OF PROCEDURE:  ____________

PROCEDURE:  Lumbar Epidural Injection

The patient/family member has been informed of the risks and the benefits of the planned procedure.

In the fluoroscopy room the patient was placed in a prone position and the skin over the lumbosacral spine was prepped and draped in a sterile manner.  The skin and deeper tissues were numbed with 1% lidocaine.  Using a translaminar approach at the ________ level, a 3½ inch 20 gauge Touhy needle was advanced under fluoroscopic guidance, using the loss of resistance technique into the epidural space.  Needle position was conformed on AP and lateral views.  Aspiration was negative for CSF and blood.  10 cc of a mixture of _________ and 80 mg of methylprednisolone was injected into the epidural space.

Patient tolerated the procedure very well.

Complications:  None.

Full discharge instructions were given to the patient.  The patient was discharged in a stable condition.