Читать книгу Neurosurgery Outlines - Paul E. Kaloostian - Страница 27

1. Informed consent signed, preoperative labs normal, no Aspirin/Plavix/Coumadin/other anticoagulants for at least 2 weeks preoperatively

2. Appropriate intubation and sedation

3. Place the patient prone in neutral position with Mayfield head holder

4. Time out performed

5. Incision along posterior cervical spine midline

6. Subperiosteal dissection of muscles down to bone performed at appropriate level (see ▶Fig. 1.9)

7. X-ray/fluoroscopic confirmation with two people for appropriate level (see ▶Fig. 1.10)

8. Laminectomy and foraminotomy unilaterally or bilaterally, if needed, depending on diagnosis and indication for surgery (see ▶Fig. 1.11)

a. Use pituitary rongeur/Kerrison rongeur and high-speed drill

Fig. 1.9 Fluoroscopy reveals trajectory of tube for cervical decompression. Identify the facet joint before placing parallel to disk space at that level. (Source: Minimally invasive tubular posterior cervical decompressive techniques. In: Vaccaro A, Albert T, eds. Spine Surgery: Tricks of the Trade. 3rd ed. Thieme; 2016).

9. Once spinal cord and/or nerve roots are decompressed, obtain X-ray confirming appropriate levels decompressed

10. If stabilization is planned, then instrumentation and fusion can be performed

11. Muscle and skin closure with drain placed (if necessary)