By Howard S. An MD
ISBN-10: 0683302604
ISBN-13: 9780683302608
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Sample text
T h e p ro p er te ch n iq u e s o f d iscecto m y an d fu sio n are c ru c ia l to s u cce ssfu l o u tco m es. N eu ro log ic co n se q u e n ce s m ay b e d evastatin g, an d b o n e graft c o m p lic a tio n s are co m m o n . P ro p er ligh tin g and CHAPTER 2: SURGICAL EXPOSURE A N D FUSION TECHNIQUES OF THE SPINE loupe m agnification o f th e su rgical field are essen tia l during discectom y. A ll o f th e d isc m a teria l is re moved, bu t th e p o sterio r lo n g itu d in a l lig am en t is usually left alone.
N ew er te c h n iq u es u se screw fix a tio n b etw ee n th e la tera l m ass o f C l an d C2 (40, 4 1 , 54). C o m p lica tio n s a sso cia ted w ith p o ste rio r o c c ip ito c e rv ic a l or a tla n to a x ia l fu sio n m ay b e d evastatin g. C are is req u ired d uring passage o f th e w ires to p rev en t in ju rie s to th e b ra in ste m or sp in a l cord. T h e v erteb ral artery m u st b e p ro tected d uring ex p o su re an d in stru m en ta tio n . T h e u se o f so m a to se n so ry evo k ed p o te n tia l m o n ito rin g is ro u tin e in m y e lo p a th ic ca ses.
B lu n t d isse ctio n lead s to th e tran sv erse processes and an terio r a sp e ct o f C l to C 3. P o te n tia l co m p licatio n s o f th is ap p ro ach in c lu d e in ju rie s to 35 th e sp in a l a ccesso ry n erv e, th e sy m p a th e tic g anglion , an d th e v erteb ral artery. Anterior Exposure of the Lower Cervical Spine T h e a n te rio r a p p ro a ch to th e lo w er ce rv ica l sp in e has b e e n w e ll d escrib e d in th e lite ra tu re (21, 6 3 , 64). T h e p a tie n t is p la ce d in a su p in e an d slig h t rev erse T re n d elen bu rg p o sitio n to m in im iz e v en o u s p o o lin g in th e su rg ica l area (Fig.