The Ahha Moments

Today I again shadowed the neurosurgeon.  The first thing that we did was a follow up surgery on the women who had the Anterior Lumbar Interbody Fusion on Monday.  The patient was morbidly obese and the surgeon had some concerns about the spine staying stable while the bone fused.  To lessen the likely hood of complications another surgery was preformed.  This one was a  percutaneous pedical screw placement where two screws and a rod where placed through two small incisions through the back like the picture below except only two entry points.

  This was a fascinating surgery because it not very invasive and required all sorts of fancy tools. The end result looked a little something like the x-ray below.
       

I also followed the surgeon as he made his rounds through the clinic.  There was one case that was especially interesting because it was a textbook case and I was able to see how a doctor can use his knowledge of anatomy and the symptoms  that the patient is having to isolate the problem.  Of course doctors do this when every they see a patient but because it was so straight forward I was able to understand the diagnosis.  A women came in with a herniated disc.  The doctor was able to locate the exact nerve being affected by how the paint went down her leg and the weakness in her leg. A dermatome is an area of skin where the feeling is mainly supplied by one spinal nerve.  From the spinal cord, from my understanding, spinal nerves come out of the spinal cord and are essentially in charge of  certain area that can be seen in the picture below.  He identified that it was either the L4 or L5 nerve that was being effected by the ruptured disc by the description of where her pain was ( From the lower back to the side of the thigh, the front of the calf and the big toe. He then tested her strength by asking her to push down with her big toe, the left side was weaker, and then to push down with the ball of her feet which showed no significant change in strength telling him that is was the L5 nerve that was being affected.  I really enjoyed seeing this direct correlation symptoms and cause.