Читать книгу Neurosurgery Outlines - Paul E. Kaloostian - Страница 18

1. Informed consent signed, preoperative labs normal, no Aspirin/Plavix/Coumadin/other anticoagulants for at least 12 days

2. Appropriate intubation and sedation

3. Horizontal skin incision 1 to 2 inches on either side of spine

4. Split thin muscle underlying skin

5. Enter the plane between sternocleidomastoid muscle and strap muscle

6. (Anterior) Enter into the plane between trachea/esophagus and carotid sheath

7. Disect away thin fascia

8. Locate disk (preoperative imaging match/intraoperative fluoroscopy)

9. Remove disk by cutting annulus fibrosis and nucleus pulposus

10. Remove entire disk including cartilage endplates to reveal cortical bone

11. Remove ligamentous tissue front to back to allow access to spinal canal

12. (Posterior) Incision on midline, behind neck

13. Elevate paraspinal muscles

14. Confirm correct level (discussed above)

15. Remove small portion of facet joint with burr drill, expose nerve root, gently move to side to expose disk herniation

16. Insert bone graft and implant cage into evacuated space

17. Attach small plate to spine with screws in each vertebral bone

18. Clean surgical site, exit, and suture