The patient is positioned prone;
thru' a longitudinal incision, the paraspinal muscles are separated only on
the ipsilateral side,and kept retracted with hemilaminectomy retracters; the interlaminar space is cleared off soft
tissues. The interlaminar ligament and the ligamentum
flavum are incised.
Clip2:
The interlaminar ligament and the ligamentum
flavum are excised with precautions to avoid injury to the
underlying dura. Up cutting punch is useful to clear the interlaminar space.
The clearance is more towards superomedially.
Clip3:
The bulging disc is visualized after
retracting the nerve root; the disc is incised and the nucleus pulposus is
being eased out.
Clip4:
Disc excision continues with punch, and scoop;
curved punch is helpful for thorough clearance. The space is probed for
residual disc and the nerve root is found to be lax confirming adequate disc
excision.