half-door laminoplasty

1. Cervical spondylosis involves more than three segmental lesions with spinal stenosis and spinal cord compression symptoms. 2. Cervical spinal canal trauma or developmental stenosis with spinal cord compression symptoms, ct tablets show that the sagittal diameter of the spinal canal is less than 10mm. 3. Scattered or continuous cervical posterior longitudinal ligament ossification has spinal cord compression symptoms, anterior surgery is difficult to decompress. 4. Cervical spondylosis has undergone anterior decompression, and there are still symptoms of spinal cord compression. Treatment of diseases: cervical spondylosis stenosis cervical spondylosis Indication 1. Cervical spondylosis involves more than three segmental lesions with spinal stenosis and spinal cord compression symptoms. 2. Cervical spinal canal trauma or developmental stenosis with spinal cord compression symptoms, ct tablets show that the sagittal diameter of the spinal canal is less than 10mm. 3. Scattered or continuous cervical posterior longitudinal ligament ossification has spinal cord compression symptoms, anterior surgery is difficult to decompress. 4. Cervical spondylosis has undergone anterior decompression, and there are still symptoms of spinal cord compression. Preoperative preparation 1. Preoperative surgical design is extremely important. The forming range is determined according to ct or mri or myelography. According to the ct image, the distance between the midline of the lamina and the left and right sides of the spinal canal (the value of the transverse diameter of the spinal canal) is measured, and the positioning reference of the ditching part in the operation is used. According to the site of compression of the epiphysis and the spinal cord, such as single-door laminectomy, the hinge side and the open side are determined. 2. Make a good plaster collar. Match the blood. Surgical procedure 1. Position: prone position. The head and face are placed on the headband, and the head and neck are slightly flexed, so that the skin behind the neck is free of wrinkles. The operating bed is maintained at a head height of 10° to 15°. 2. Incision: a median longitudinal incision in the posterior neck. The length depends on the exposure of the vertebrae. In order to reduce bleeding, subcutaneous and intramuscular infiltration with 1:500,000 epinephrine saline (adrenalin 1mg plus saline 500ml) is contraindicated in patients with cardiovascular disease and hypertension. 3. Reveal the lamina: cut the skin and ligaments in the middle. The cervical spine muscle was peeled off against the spinous process lamina, and it was peeled off while blocking the bleeding with dry gauze. Pull the muscles apart on both sides to reveal the lamina on both sides. 4. Laminar groove formation: Clean the soft tissue remaining on the lamina. According to the transverse diameter of the spinal canal measured before the ct piece, the groove is determined on the lamina, and a longitudinal groove is drilled or bitten on both sides of the lamina, and then the micro-drill or the tip is used. The rongeur clamps the ditch. The shallow width of the groove is narrow at a depth of 2 to 3 mm and is v-shaped. The depth of the groove is different on both sides. The side of the lamina forming the hinge only needs to reach the inner cortex of the lamina (formation of the green branch fracture after opening the door), and the side of the opening should be cut through the full layer of the lamina until the hard ridge is revealed. Until the film. The grooves in the predetermined range are grooved one by one. 5. Open the unilateral lamina: After the groove is made, cut the ligamentum flavum on the upper edge of the vertebral plate and the ligamentum flavum on the lower edge of the lowermost lamina. The surgeon presses the spinous process to the lamina with fingers. The side of the hinge is split open, and the unbroken yellow ligament remains in the groove on the side of the open door, and the door is slowly opened. At the same time, the epidural adhesion is separated by the epidural stripper into the lamina, so that the sagittal diameter of the spinal canal is increased to normal range. At this point, the dural sac bulges and the pulsation is restored. Generally, for every 1 mm increase in the clearance, the sagittal diameter can be increased by 0.5 mm. According to the degree of stenosis, the unilateral lamina opening gap can be increased to 6-8 mm. If the door is not enough to decompress, the v-shaped side of the hinge should be widened and then widened. The door must not be forcibly opened, causing the hinge side to break and not functioning as a hinge, which affects the opening of the door. 6. Suspending the spinous process at the paravertebral: drill the hole at the root of the spinous process of the open lamina, and take the metal wire or the 7th wire through the root to fix the fascia or cervical spine muscle at the paravertebral joint. This fixation must be secure so as not to cause a "closed door" failure after surgery. Take a thin fat sheet of the same length as the dural, covering the exposed dura mater. 7. Stitching: The diseased spinous processes are trimmed and only 1 to 1.5 cm long. The bitten spine of the spine is cut into pieces after removing the soft tissue, and is placed on the hinge side groove without being closed for bone grafting. The wound was rinsed clean and no bleeding was observed. After the cotton sheet and gauze were left, the incision was sutured layer by layer. The incision has a built-in No. 14 catheter, which is used as a small incision next to the incision for extracorporeal drainage.