Cervical hemilaminectomy and decompression

Spinal canal decompression is a method of relieving spinal cord and nerve compression due to spinal canal stenosis. Decompression can be performed on any part of the spine in the spinal canal. The compression site and nature are different, and the decompression route and method are different. Curing disease: Indication Cervical vertebral laminectomy decompression is applicable to: 1. The lamina and the ligamentum flavum itself are hypertrophied and oppress the spinal cord. 2. Local tumors and inflammation of the laminectomy require local resection. 3. Localized spinal stenosis such as laminar fracture and collapse, causing intraspinal compression. 4. All-side unilateral neurological symptoms, or intraspinal space-occupying lesions confirmed by imaging examination that the pressure-inducing substances are confined to the posterior side of the spinal canal, and can be performed in the corresponding vertebrae. Pipe exploration. For lesions of 5.3 or more segments, the anterior decompression can be performed first, and then the posterior decompression is mainly used to reduce the effect of decompression. Contraindications 1. Poor general condition, combined with important organ dysfunction. 2. Cervical anterior structural damage, with obvious instability, should be decompressed after anterior fusion. 3. Patients with severe cervical spinal stenosis should be used with caution. Preoperative preparation 1. Preoperative training prone position to meet the needs of intraoperative position. 2. Regular skin preparation, including hair shaving clean. 3. Determine the site of decompression based on clinical and clinical imaging signs. Surgical procedure Incision The posterior median neck incision is centered on the injured segment, and its length should include the spinous processes of the upper and lower vertebrae of the injured segment. According to the level of the damage, the incision can be extended up and down to achieve good exposure. Generally spontaneously from 1.0 cm to the seventh cervical spine. 2. Laminar exposure Cut the skin and subcutaneous tissue to the surface of the ligament, cut the ligament from the surface of the spinous process from one side, cut the spinous process and lamina along the side of the lamina, and use the periosteal stripper to make the periosteum from the inside to the outside. Peeling, filling the hemostasis with dry gauze, sequentially exposing the cervical 7 to the cervical half of the lamina and articular processes, and retracting the posterior cervical muscles with an automatic retractor and fixing. 3. Semi-laminectomy The extent of the cut is determined as needed. Usually in the neck 3 ~ 6 or neck 3 ~ 7, the medial from the base of the spinous process, the lateral side of the joint joint. Usually starting from the far side, proceeding to the near side. The attachment point of the lower edge of the superior lamina and the ligamentum flavum was separated by a sharp nerve stripper. The lamina was removed using a thin impact laminar rongeur. This is a semi-laminectomy. Once the compressed spinal cord is decompressed, it rapidly expands into the decompression zone. The residual bones in the base of the spinous process and the medial edge of the facet joint may interfere with dural expansion. The base of the spinous process is successively used by a thin-mouth impact rongeur. The bone is removed to make it sloped. Because the facet joints are close to the vertebral arch and the intervertebral foramen, there are many vascular stenosis, which is easy to tear and heel, and need to be carefully separated when resecting. The medial part of the facet joint is excised, and the spinal cord floats toward the decompression side. complication Spinal cord injury Is the main complication, the reasons: 1 rough movement, surgical instruments, especially the rongeur, too thick, each time into the lower part of the lamina may be a compression; 2 laminar and yellow ligament adhesion, not separated or separated Sufficiently, the dura mater is torn when the lamina is bitten. 2. Cerebrospinal fluid leakage It is a common complication after posterior cervical laminectomy and decompression, especially in patients with severe spinal stenosis, which may be due to dural tears not found during surgery, or have been found but considered too small to be repaired. Can also be due to spinal cord decompression after dural sac expansion and bone friction around the decompression area, and the tightness of the muscle layer is not tight, resulting in cerebrospinal fluid leakage, local compression 3 ~ 5d can often be suspended, a small need to debride Stitching.