Читать книгу Neurosurgery Outlines - Paul E. Kaloostian - Страница 79

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. C-arm fluoroscopy equipment set up in operation zone

7. Make midline incision two levels above and below the level of trauma, preserving the fascia

8. Perform dissection to lateral edge of transverse processes

9. Remove posterior elements and bilateral facets, exposing thecal sac and pedicles

10. Remove pedicles with drill, exposing vertebral body bilaterally

11. Perform corpectomy:

a. Using Pituitary rongeurs and 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

12. Place posterior pedicle screws and rods two levels above and below the level of corpectomy

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