anterior foraminotomy

The posterior lateral and lateral spurs of the vertebral body (Fig. 4.17.2-1), which were compressed by the anterior cervical approach, were reported by Japanese scholars Changdao and Baima. The surgical methods include the keyhole fenestration method and the intervertebral disc intervertebral window opening method. The purpose of the operation is to remove the posterolateral or lateral sciatic vertebral body of the anterior wall of the intervertebral foramen and relieve the compression of the nerve root. In the two methods, the latter surgery is more fully revealed. Jho (1996) also reported a similar anterior approach to open window, 30 cases of surgery, with good results. Treatment of diseases: cervical congenital fusion malformation cervical disc herniation Indication Anterior intervertebral foramitomy is applicable to: 1. There are obvious symptoms of nerve involvement in upper extremity, local muscle atrophy, etc., and the effect of conservative treatment is not obvious. 2. The posterolateral or lateral spur of the vertebral body was confirmed by cervical X-ray oblique slice and cervical CT transverse plane, and consistent with clinical symptoms. Contraindications 1. The time of illness is short and the symptoms are mild. 2. Symptoms relieved after head traction or physical therapy. 3. From the articular surface spurs to compress the nerve root from the back. Preoperative preparation Skin and instrument preparation for bone removal on one side of the tibia. Surgical procedure Neck incision In the plane of the fractured vertebral body, from the anterior cervical line to the left or right sternocleidomastoid anterior border, the left or right transverse incision is 6-8 cm long, and the recurrent laryngeal nerve can be less pulled when the left incision is made. . The incisions are peeled up and down along the subcutaneous tissue, respectively. 2. Reveal the front of the vertebral body The platysma and deep fascia were cut along the anterior border of the sternocleidomastoid, and the sternocleidomastoid and carotid sheath were pulled to the outside; the thyroid, trachea and esophagus were pulled to the medial side. Often thyroid venous obstruction is revealed and can be sheared after electrocoagulation or ligation. The loose connective tissue is peeled off to the deep part, and the finger can touch the front of the cervical vertebra in the middle line, revealing 3 to 4 vertebral bodies. At this point, the automatic retractor can be replaced, taking care not to damage the esophagus. In the 3~4 plane of the neck, the superior thyroid artery and the superior laryngeal nerve can be encountered, and the upper thyroid artery should be cut off when the 2~3 intervertebral space of the neck is exposed. In the 7-plane of the neck, the inferior thyroid artery and the recurrent laryngeal nerve can be encountered. Carefully pull it down and do not damage the recurrent laryngeal nerve. 3. Vertebral body positioning Generally, after the front of the vertebral body is exposed, two syringe needles are applied, respectively, and the depth of the intervertebral space and the adjacent intervertebral space are respectively penetrated to a depth of 1.5 cm. If the depth is too deep, there is a risk of stabbing the cervical spinal cord. The X-ray cervical lateral radiograph is taken next to the operating table, and after the wet film is washed out, the vertebral body and the upper intervertebral space can be determined. 4. Keyhole method for removing bone spurs In the intervertebral space, the medial part of the longus muscle is exfoliated along the periosteum, and the lateral spur of the hook joint and the anterior root of the transverse process are exposed. Because the apex of the spur is close to the vertebral artery, the spur should be placed with great care. The surface is peeled off, and it is best to operate under the operating microscope at this time. When the top of the spur is peeled off, it is separated from the vertebral artery by gauze to protect the artery from damage. Then, a high-speed micro-drill is drilled into the intervertebral space and the lateral part of the vertebral body, which is equivalent to a bone window of 1 cm in diameter at the hook joint of the spur base, and the depth is about 1.5 cm. At this time, the hook joint and the outer part of the disc are both After grinding, a hole is formed at the bottom of the bone spur, and the bone spur can be collapsed into the cavity to be removed. Continue to remove the anterior wall of the foramen and the posterolateral sinus of the vertebral body with a micro drill, a curette and a Kerrison rongeur in front of the nerve root to completely relieve the compression in front of the nerve root. 5. Intervertebral window opening method The surgical procedure is similar to Smith Robinson anterior decompression. A high-speed micro-drill is used to make a transverse rectangular bone window in the intervertebral space of the lesion, revealing the spur of the posterior longitudinal ligament and the posterolateral compression of the vertebral body. The interbody fusion device is used to enlarge the intervertebral space, and then the curette and ultra-thin Kerrison The rongeur removes the spur of the posterior aspect of the vertebral body in front of the intervertebral foramen. Then the humerus was taken for interbody fusion. 6. Suture incision The anterior longitudinal ligament flap should be sutured as much as possible to prevent the bone column from coming out. Before withdrawing the automatic retractor and closing the incision, the bipolar electrocoagulation is used to stop the bleeding, because once the neck hematoma occurs, it may cause difficulty in breathing and even suffocation. The drainage of the silicone tube should be deep in front of the vertebral body. The sternocleidomastoid and deep fascia are sutured, and the platysma, subcutaneous tissue and skin are sutured layer by layer. complication Postoperative hematoma The swelling of the operation should be closely observed within 1 to 2 days after the operation. If it is found that the breathing is difficult and the local hematoma is suspected, the wound should be opened quickly for treatment. 2. Postoperative neurological symptoms worsen The cause should be analyzed. If there is bleeding or the sacral column is inserted into the deep compression spinal cord, surgery should be performed again. 3. Bone column prolapse When affecting hypopharyngeal function, re-implantation should be taken out. 4. The sound is low and hoarse Intraoperative injury caused by laryngeal and recurrent laryngeal nerve. The superior laryngeal nerve is accompanied by the vagus nerve and is accompanied by the superior thyroid artery. It enters the larynx to innervate the inferior pharyngeal muscle, the ring muscle and the larynx mucosa. After the injury, the sound is low and thick, and the throat has no sensation. The recurrent laryngeal nerve is adjacent to the thyroid gland. The artery moves upwards in the outer edge of the trachea and esophageal sulcus, and enters the larynx to control the movement of the vocal cords. The vocal cords on one side are paralyzed and hoarse. Therefore, the surgeon must be familiar with the vagus nerve and the two major branches of the walking and anatomical relationship, when separating and cutting the upper and lower thyroid artery must pay attention to protect the two nerves, such as due to the retractor tension and excessive hoarseness, should be hoarse Relax the retractor.