Extended Hemislaminectomy and Decompression

Cervical spinal cord injury occurs quadriplegia, serious condition, respiratory complications often occur, and the mortality rate is high, so it is urgent to treat it. Cervical spinal cord injury includes complete spinal cord injury, incomplete spinal cord injury, brown Sequard syndrome, central spinal cord injury, anterior spinal cord injury, posterior spinal cord injury (posterior) Spinal cord injury and other types of spinal cord injury without fracture and dislocation. Different types of cervical vertebrae have different indications for surgical treatment. For example, anterior spinal cord injury or central spinal cord injury caused by cervical burst fracture or cervical intervertebral disc injury, requiring cervical anterior decompression surgery, and central spinal cord injury or anterior spinal cord injury caused by cervical posterior extension injury , the need for posterior decompression surgery of the cervical spine. Treatment of diseases: closed spinal cord injury spinal cord compression Indication Expanded semi-laminectomy and decompression for: 1. Cervical vertebrae without fracture and dislocation of spinal cord injury, with spinal stenosis (determined by MRI), regardless of the presence or absence of disc herniation, mostly central spinal cord injury. 2. Lower cervical spine fracture and dislocation, dislocation within 1 degree, posterior extension can be reset or has been an old spinal cord injury. 3. Burst fracture, but no dislocation, with spinal cord injury. Preoperative preparation X-ray films of the cervical spine were observed, and the 2~5 spinous process bifurcations of the neck were observed. The intraoperative localization markers were observed. MRI examination showed the compression segment and extent of the spinal cord. Most of them were compressed by the neck 4-6, and the neck 3 or neck 7 was also accepted. Pressure, as the basis for the decompression length, the side of the decompression side: the side of the clinical movement or the side of the MRI transverse section that is pressed. Surgical procedure 1. The midline incision of the item reveals the lamina of the side to be cut, and the neck 7 and the neck 6 and 7 spinous processes and one side of the lamina are exposed from the bottom to the top, and the upper neck 5 is bifurcated to the neck 2, which needs to be separated from the midline. On both sides of the head (neck) semi-spinus muscle, the neck 2 ~ 5 spinous processes were revealed, and the sharp cut was attached to the upper semi-spine of the bifurcation, showing the lateral lamina. 2. Separate the ligamentum flavum and the lamina at the lower edge of the cervical 7 lamina, insert the thin lip laminar rongeur, remove the lamina, leave the ligamentum flavum, and the ligament and lamina Then bite off to the lower edge of the neck 2, then return to the upper ligament of the neck 7 to the upper edge of the chest 1 and bite out to the inner edge of the facet, and then bite the oblique side to the deep side of the spinous process root. It may include its ligamentum flavum. Once the width is sufficient, the spinal cord dura protrudes to the level of the facet joint, which is equivalent to 2/3 of the transverse diameter of the dura mater, indicating that the decompression is fully decompressed and the dura mater can be recovered. 3. For fracture dislocation or simple dislocation, the upper and lower spinous processes of the dislocation gap can be fixed by the wire, and the contralateral lamina can be exposed, and the bite bone will be implanted between the two opposite lamina. For those without fracture and dislocation, the drainage tube is flushed and the incision is closed.