Читать книгу Neurosurgery Outlines - Paul E. Kaloostian - Страница 78

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 prone on Jackson Table with all pressure points padded

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

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

6. Make 4 cm incision, 4 cm laterally from midline

7. Remove proximal rib, costovertebral ligaments, rib head, intercostal vessels, and ipsilateral pedicle

8. Perform corpectomy, preserving ventral body, anterior longitudinal ligament, and contralateral vertebral margins:

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

9. Perform spinal fusion:

a. Perform reconstruction using titanium mesh, autograft, and/or expandable cages

i. Supplement with vertebral body screws and rods if deemed necessary

b. Place posterior percutaneous screws and rods above and below the level of corpectomy

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

11. Remove retractor and inspect wound for further bleeding

12. After appropriate hemostasis is obtained, muscle and skin incisions can then be closed in appropriate fashion