1. preoperative must be detailed questioning and physical examination (symptoms heavy, signs light)
Chinese medicine look and feel, Western medicine depending on the amount of touch, just look at the film to advise you to operate the doctor, responsibility is not good where! Ling Qinjie, Department of Spine Surgery, The First Hospital of Guangzhou Medical University
Case presentation: patient male 44 years old
History: right hand pain and walking weakness for 3 months
Diagnosis: mixed cervical spondylosis (nerve root type, spinal cord type)
After conservative treatment (nerve nutrition, circulation improvement, blood sugar control, physiotherapy, etc.), the pain in the right hand was reduced, but the symptoms of weakness in the limbs and intermittent claudication gradually increased (less than 50 meters), and the feeling of stepping on cotton in the foot was serious.
2. Imaging examination
3. Differential diagnosis
Exclusion: 1. spinal cord tumor 2. posterior longitudinal ligament ossification 3. amyotrophic lateral sclerosis 4. spinal cavernous disease
4. Indications for surgery
If conservative treatment fails to relieve the spinal cord, the symptoms and signs gradually worsen.
5. Preoperative examination – risk assessment
(No abnormalities in chest X-ray, electrocardiogram, cardiac ultrasound, liver and kidney ultrasound) No serious organic lesions in major organs and no absolute contraindications to surgery.
6. Surgical plan development
Anterior cervical 5/6 discectomy, spinal canal decompression, intervertebral bone graft fusion (ROI-C system)
7. Pre-operative preparation
1) Push tracheal and esophageal training
2) Bedside urination and defecation training
(3) Routine fasting, water fasting, skin preparation, etc., antibiotic drip half an hour before surgery, etc.
8. Surgical procedure
Removal of intervertebral disc
Placement of fusion device
Retain drainage tube, suture the wound
9. Postoperative care
1）Protective cervical brace and braking
2）Encourage the patient to cough and cough up sputum
3）Gauze (without cotton pad) to cover the wound for easy observation (bedside pneumonectomy bag)
4）Remove the drainage tube after 24 hours
(5) Wearing a neck brace on the second postoperative day to gradually walk on the ground for functional exercise (with personal supervision)
6）No stitches need to be removed from the wound, but only after 6 days of wet water
(7) If there is no special, 5 days after surgery can be discharged, the neck brace fixed 4 ~ 6 weeks
After recovery, the wound is 3cm, which cannot be seen without careful examination
Cervical spine surgery is actually less traumatic than lumbar spine surgery, with shorter surgery time and faster response.
But the technical requirements are higher! It is not as scary as you think!
This article is authorized by Dr. Ling Chin-Chieh, please do not reproduce without authorization