[3369432]
On (b)(6) 2012, this pt with spinal stenosis with neurogenic claudication l4-5 and compression fracture l4-5 had a laminectomy of l3, posterolateral instrumented spinal fusion l3 to l5, open biopsy of left l4 pedicle, use of calcium phosphate osteoconductive material, use of morsellized allograft bone and a partial l5 laminectomy was also performed. While his fracture was benign in appearance, it was deemed appropriate to perform a biopsy of the vertebral body as well as the left l4 pedicle to ensure that there was no pathologic nature of this fracture. This was done by decorticating the confluence of the transverse process lateral joint surface and pars interarticularis on the left hand side. The pedicle was then breached using a blunt pedicle finder. A small curette was then used to gently remove cancellous bone from the vertebral body as well as the pedicle. While this was being done, the tip of a small angled curet broke off. Attempts were made to remove this. This was not possible. C-arm magnification confirmed appropriate location of this tip in the vertebral body. It was felt that removing this would cause undue harm to both the bony structures and possible neural elements. Given that the instrument was clean and imbedded in the vertebral body, it was also felt that no undue risk would be posed by leaving this piece of hardware in its place.
Patient Sequence No: 1, Text Type: D, B5