In this photo the muscle retractor is in place and the bayonetted nerve root retractor is mounted and ready to be put in place. Its flexibility will be restored by loosening the wire-tightening lever. It will be tightened again when the retractor is in position. A cautery forceps (rt. hand) and a suction tip (L. hand) are being used to control some epidural venous bleeding so those veins can be divided if needed to release the nerve root. The dura and nerve root will then be retracted and held out of the way by the automatic retractor while the disc herniation is treated.
This patient is asleep on their stomach, with the head toward the top-left, where some of the anesthesia equipment is visible. Light for the microscope is transmitted from a box on the scope stand via a fiberoptic cable that projects light down through the center of the objective lens. The sterile plastic microscope drip has been partially illuminated by the regular overhead light.
There is an increased risk of infection when using the operative microscope, probably due to the surgeon touching the un-draped area around the eye-pieces without realizing it. An annoying problem, good to have, is that patients feel better so fast that it’s hard to make them be careful for six weeks while the disc defect heals well enough to prevent a recurrent herniation.
For a full description of lumbar microdiskectomy, go to http://www.lobakapp.com, click on my resume on the first page, scroll down to the list of publications and Google either reference six, which is in a textbook and may be hard to find online, or ref. 38.