Читать книгу Neurosurgery Outlines - Paul E. Kaloostian - Страница 77

1. Informed consent signed, preoperative labs normal, no Aspirin/Plavix/Coumadin/NSAIDs/Advil/Celebrex/Ibuprofen/Motrin/Naprosyn/Aleve/other anticoagulants and anti-inflammatory drugs for at least 2 weeks

2. Appropriate intubation and sedation and lines (if necessary) as per the anesthetist

3. Patient placed in left/right lateral decubitus position with padding of upper and lower extremities, held in place with tape over upper and lower extremities

4. Fluoroscopy is used to confirm that no vertebral movement has occurred

5. Neuromonitoring may be required to monitor nerves (if necessary and indicated)

6. Time out is performed with agreement from everyone in the room for correct patient and correct surgery with consent signed

7. Make 6 cm incision from posterior axillary line to 4 cm lateral of midline

8. Dissect toward the rib head:

a. Perform rib resection

b. Incise endothoracic fascia, dissecting off the parietal pleura

c. Dissect areolar tissue until endothoracic fascia is opened over rib head

9. Take down costovertebral ligaments and proximal rib head, exposing vertebral body

10. Perform corpectomy in a pedicle-to-pedicle fashion, preserving anterior shell of bone and anterior longitudinal ligament:

a. Using hand-held curved high-speed drill, remove the posterior wall of vertebral bodies

b. Remove the vertebral bodies and disks associated with the trauma

c. Introduce hemostatic agents, if necessary, to control bleeding

d. Achieve hemostasis

11. Perform spinal fusion

a. Perform reconstruction with expandable cage and autograft

b. Perform ventrolateral screw-plate fixation

c. Perform midline posterior incision and place posterior percutaneous screws

12. Place chest tube if significant pleural tear occurs (can be removed in 2–3 days)

13. Remove retractor and inspect wound for further bleeding and pleural violations

14. Place red rubber catheter between endothoracic fascia and parietal pleura

15. Close fascia with suture

16. Catheter under water seal; the patient is made to valsalva with help of anesthesia

17. Remove catheter and tighten last facial suture

18. Close the muscle, subcutaneous layers, and skin