Neurosurgery Outlines - Paul E. Kaloostian Surgical Outlines

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to allow access to spinal canal

      12. Insert bone graft and implant cage into evacuated space

      13. Attach small plate to front of spine with screws in each vertebral bone (see ▶Fig. 1.2 to ▶Fig. 1.4)

      14. Clean surgical site, exit, and suture

      15. If posterior approach is needed, place the patient prone with Mayfield head pins with all pressure points padded

      16. Dissect to lamina over affected levels and confirm levels on X-ray

      17. Perform laminectomy and foraminotomies over affected levels that are stenotic and place lateral mass screws with rods and bone graft if needed over affected levels for fusion

      18. Obtain hemostasis, place drain, and close wound in multiple layers

      Pitfalls

      • Loss of neck mobility by ~30%

      • Intraoperative cerebrospinal fluid (CSF) leak

      Fig. 1.2 (a, b) Cord decompression, corpectomy (C5), and fusion (C4–C6) were performed. The fusion healed within one year. (Source: Diagnostic Features. In: Vialle L, ed. AOSpine Masters Series, Volume 5: Cervical Spine Trauma. 1st ed. Thieme; 2015).

       image

      Fig. 1.3 (a–d) A patient suffered cervical trauma resulting in C3/C4 dislocation. Fusion (C3–C4) was performed and lateral mass screw placement was verified using X-ray and CT scan. (Source: Cervical case studies. In: Perez-Cruet M, Fessler R, Wang M, eds. An Anatomic Approach to Minimally Invasive Spine Surgery. 2nd ed. Thieme; 2018).

      • Blood clot (deep vein thrombosis, or more severe pulmonary embolism)

      • Damage to spinal nerves and/or cord

      • Postoperative weakness or numbness or continued pain

      • Postoperative wound infection

      • Continued symptoms postsurgically/unresolved symptoms with no improvement to quality of life

      Fig. 1.4 A man suffered cervical trauma after a bicycle accident, resulting in traumatic disk herniation. Radiology revealed associated cord contusion and C3–C4 instability. Fusion (C3–C4) was performed and after therapy, his paresis reduced. (Source: Brembilla C, Lanterna L, Gritti P, et al. The use of a stand-alone interbody fusion cage in subaxial cervical spine trauma: a preliminary report. J Neurol Surg A Cent Eur Neurosurg 2015;76(01):13–19).

      Prognosis

      • Most patient are hospitalized for 1 to 2 days, then return home with strict orders of minimal sudden head/neck movement

      • Typically, 4 to 6 weeks post operation most patients are able to return to normal day-to-day activities

      • Full fusion (formation of hard bone) may take 12 to 18 months

      • Physical therapy (PT) and occupational therapy (OT) should strongly be considered

      1.2 Elective

      1.2.1 Anterior Cervical Fusion/Posterior Cervical Fusion

      Indications

      • No complete arch of C1

      • Bursting C1 fracture

      • Congenital abnormalities

      • Odontoid movement into foramen magnum

      • Vertebral shifts

      Symptoms and Signs

      • Stiff neck

      • Sharp pinpoint pain in neck

      • Soreness lasting >7 days

      • Weakness in neck muscle

      • Tingling/Numbness in general neck area

      • Trouble gripping objects

      • Tingling in finger tips

      • Frequent tension headaches (~4+ days per week)

      Surgical Pathology

      • Spondylosis

      • Spondylosis

      • Adjacent segment pathology (ASP)

      • Radiculopathy (see ▶Fig. 1.5)

      • Osteomyelitis

      • Vertebral body tumors

      • Myelopathy (see ▶Fig. 1.6 and ▶Fig. 1.7)

      • Postlaminectomy kyphosis (see ▶Fig. 1.8)

      • Opacified posterior longitudinal ligament

      Fig. 1.5 (a, b) An elderly woman with neck pain and deformity from myelopathy received posterior decompression (C3–C6), anterior diskectomy and fusion (C4–C5), and posterior fusion (C2–T2). A transition rod was added for stabilization. (Source: Radiographic considerations. In: Ames C, Riew K, Abumi K, eds. Cervical Spine Deformity Surgery. 1st ed. Thieme; 2019).

      Fig. 1.6 (a, b) An elderly man with chin-on-chest deformity (kyphosis) received anterior and posterior cervical osteotomies. Posterior fusion (C2–T10) was performed and resulted in significant correction of the kyphosis. (Source: Radiographic considerations. In: Ames C, Riew K, Abumi K, eds. Cervical Spine Deformity Surgery. 1st ed. Thieme; 2019).

      Fig. 1.7 (a, b) An elderly woman with neck pain from myelopathy received posterior decompression and fusion (C3–C6). This was followed by a diskectomy and osteotomy (C6–C7), posterior fusion (C2–T2), and laminectomy (C6/7 and C7/T1) for decompression. (Source: Radiographic considerations. In: Ames C, Riew K, Abumi K, eds. Cervical Spine Deformity Surgery. 1st ed. Thieme; 2019).

      Fig. 1.8 (a, b) Landmarks for posterior cervical tubular decompression via foraminotomy. After identifying the lamina–facet junction and other bony landmarks, commence laminar resection. (Source: Minimally invasive tubular posterior cervical decompressive

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