Anterior decompression for cervical spondylosis

1. Spinal cord cervical spondylosis with spinal cord compression symptoms, cervical disc herniation, posterior longitudinal ligament ossification (isolated). 2. Cervical spondylotic radiculopathy, which is ineffective after conservative treatment, has severe symptoms and recurrent attacks. 3. Vertebral artery type cervical spondylosis has repeated dizziness, falling symptoms, long-term treatment by conservative treatment, and vertebral angiography, to determine the surgical interpretation of the oppression. Treatment of diseases: cervical spondylotic cervical spondylosis Indication 1. Spinal cord cervical spondylosis with spinal cord compression symptoms, cervical disc herniation, posterior longitudinal ligament ossification (isolated). 2. Cervical spondylotic radiculopathy, which is ineffective after conservative treatment, has severe symptoms and recurrent attacks. 3. Vertebral artery type cervical spondylosis has repeated dizziness, falling symptoms, long-term treatment by conservative treatment, and vertebral angiography, to determine the surgical interpretation of the oppression. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation 1. Before the operation, the trachea and esophagus should be trained. Because of the anterior cervical approach, the trachea and esophagus should be pulled to one side during the operation to reveal the vertebral body. The operation is usually on the right side of the road, so the patient should push the trachea and esophagus to the left side for training, and can persist for about 30 minutes. This can prevent accidental injury or affect surgery due to reflex cough, suffocation, and sway caused by pulling the trachea during surgery. 2. Prepare the neck circumference or plaster neck, and prepare for external fixation after operation to prevent the wound from bleeding after the neck activity is too large, and the bone graft will fall off. 3. Conventional preoperative preparation and blood matching. 4. Regular positive, side, oblique x-ray film inspection. Oopll (posterior longitudinal ligament ossification) should be a tomogram; conditional should be ct, ctm (ct myelography) or mri examination. 5. Surgical patients are generally older, and should be aware of heart, lung, liver, kidney function and hemorheology before surgery, and take preventive measures. Surgical procedure 1. Position, incision, and exposure: See the anterior side of the cervical spine (see the way the spine is revealed). 2. Positioning: In the midline between the two longissimus dorsi muscles, the anterior fascia is cut longitudinally, and the fascia is pushed away from the fascia by the periosteal stripper to reveal the vertebral body and the intervertebral disc. The intervertebral disc is white, slightly above the plane of the anterior border of the vertebral body. The vertebral body is gray and slightly concave in the intervertebral disc. Take a needle without a pointed needle, cut it into a length of 1 cm, insert it into the exposed intervertebral disc, and position the lateral radiograph of the cervical vertebra. If the vertebral body of the lesion has a specific shape of lip-like hyperplasia, it can also help identify the position. During the filming, the patient's upper limbs should be pulled distally to facilitate the development of the lower cervical vertebrae in the x-ray film. The necks 6, 7 are unclear in the lateral slices, and the positioning needles can be inserted into the normal intervertebral discs of the diseased vertebrae to facilitate the positioning of the needles. If you have a TV x-ray machine, you can simply position it under fluoroscopy. 3. Resection of the lesion (1) Ring saw method: After positioning is determined, the anesthesiologist should keep the patient's neck in a neutral position. Taking the indication of the ring saw, the drill core is inserted into the intervertebral disc of the lesion longitudinally, vertically, and centered, and the upper and lower sides of the vertebral body are involved in the vertebral body. Take the corresponding ring saw, put it outside the drill core handle, rotate left and right, so that the ring saw serrated screw into the vertebral body bone and the intervertebral disc, slightly pressurized and steady in the clockwise direction. When rotating, the saw handle is prevented from shaking to the left and right, and the bone block may be broken due to shaking, which makes the operation difficult. With deep drilling, when the ring saw enters the trailing edge of the vertebral body, the surgeon can feel a hairy feel. At this time, it should be safely and slowly drilled, and pay attention to the exposed scale of the core handle. If the core handle rotates with the ring saw, the bone block in the ring saw has moved and the ring saw has penetrated the vertebral body. At this time, when the ring saw is rotated, no pressure is applied, and the ring can be rotated slightly to the right or left or counterclockwise. If there is adhesion outside the dural sac, you may feel a tear, and the movement must be slow and light. When the core handle rotates 180° with the ring saw, the ring saw and the core handle can be swung up, and the ring saw, the core and the drilled bone can be pulled out. Check whether the bone is intact and the disc surface of the disc is not broken. The vertebral body is drilled with 6 ° C ~ 8 ° C frozen saline, when there is bleeding in the hole, the bone wax is temporarily stopped to keep the bone hole clean. After blocking the hemostasis with dry gauze, combined with ct display, scrape with a small curette or use a gun-type rongeur to bite all the epiphyses of the posterior border of the vertebral body. Use a gelatin sponge to gently block the wound to stop bleeding for bone grafting. (2) Resection of the disc by the bone knife method: After the positioning is determined, the thin bone knife with a width of about 1 cm is used to cut into the upper and lower vertebral bodies of the diseased intervertebral space by 3 to 5 mm, and the vertical direction is performed. The chiseling force is gentle and stable, and slowly Chiseling, the depth is about 1 ~ 1.2cm is suspended; followed by the inner edge of the long neck muscles on both sides, the knife is inserted into the intervertebral disc. Connect the upper and lower chisel edges and take out the rectangular vertebral body and the disc block. Use a curette or a gun-type rongeur to remove the remaining disc tissue and the posterior margin of the vertebral body. Rinse with 6 ° C ~ 8 ° C frozen physiological saline, temporarily filled with gelatin sponge to stop bleeding, in order to prepare bone graft. 4. Bone sacral bone removal: generally in the anterior and middle humeral epiphysis incision, revealing the humerus, according to the size and shape of the opening at the cervical vertebrae. If you use a ring saw to open a hole in the cervical spine, use a ring saw that is larger than the size of the ring saw. On the tibia, drill one or more bone blocks according to the operation. If a thicker bone is needed, the bone is taken from the back. The residual bone of the tibia was coated with bone wax to stop bleeding, and the humeral wound was sutured layer by layer. The soft tissue attached to the drilled bone block is removed and trimmed according to the size of the cervical spine opening, and then covered with physiological saline gauze for use. 5. Bone graft fusion: When the neck is bone grafted, the anesthesiologist should be required to properly pull the patient's head to expand the cervical intervertebral space. The bone graft is placed in the bone hole of the ward, and the bone graft is placed flat on the bone graft, and the hammer is gently beaten to make the bone graft deeper and slightly lower than the front edge of the cervical vertebral body or the same. 1 (6)]. Relax the neck, flex and turn the neck to check if the bone graft is firmly embedded. If the bone graft is firmly embedded, the wound can be sutured. 6. Closing the wound: After the wound is washed, no bleeding is detected, no foreign matter remains, and the anterior rubber sheet is drained, and the incision is sutured layer by layer. complication 1. 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 worsened. 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. The bone column is prolapsed. 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.