Surgical Approaches to the Spine
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Now is its revised and expanded third edition, including nine new chapters, this step-by-step, state-of-the-art procedural manual covers over 50 unique surgical approaches for injuries and conditions of the spine. Generously illustrated, various surgical approaches to the cervical, thoracic and lumbar spine are clearly enumerated and described, including anterior, lateral, and posterior approaches and the worldwide movement toward the use of tubular retractors for a multitude of approaches. Written and edited by leaders in the field of spine surgery, this updated edition will be an invaluable resource for orthopedic surgeons, neurosurgeons and sports medicine practitioners alike.
C1, and C2 21 make the craniocervical junction slightly more accessible in patients with complex congenital malformations or tumor. An integrated transoral system of gags and retractors (Codman and Shurtleff, Randolph, MA) with bayoneted instruments of the appropriate length has allowed the procedure to become routine in many centers. The advantages conferred by the use of an operating microscope (coaxial lighting and stereoscopic vision) are essential for all but the simplest transoral
morphine dose with a careful check on respiratory rate. Physiotherapy Chest physiotherapy and mobilization are most important, and the patient is usually sitting up out of bed within 48 hours. Conclusion Postoperative Management General Mouth and Nasal Care Great care is taken with the mouth and nose. Hydrocortisone cream is applied at the end of the procedure and every 6 hours for the first 2 postoperative days. General mouth care is given every 4 hours; no food is given by mouth for 5 days,
3. Identify the anterior border of the sternocleidomastoid muscle (Fig. 11.2). As with all the anterior medial approaches, this is the key to proper orientation at this level. Develop the interval between the medial border of sternocleidomastoid and the strap muscles (Fig. 11.3). Spread longitudinally the entire length of the anterior sternocleidomastoid border. Reware of the mandibular branch of the facial nerve in the cephaladmost extent of the exposure. 4. After the borders of the
the larger, more prominent white surface of the intervertebral disc, remembering that the major intercostal vessels course over the vertebral bodies, which are the valleys between the discs. As the venous drainage is different on the right side than on the left side of the body, these veins should be identified and not damaged. Elevate the parietal pleura with small forceps and incise with a knife. Extend the incision longitudinally over the vertebral bodies the length of the necessary operative
(Fig. 29.9). 11. Blunt dissection sweeping the material left to right off the front of the disc allows insertion of the four Freebodytype Steinmann pins into the L5 and S1 vertebral bodies (Fig. 29.7) or positioning of special Deaver-type retractors. Again, beware of the left common iliac vein when inserting the Steinmann pins. 12. With isolation of the L5–S1 disc and X-ray confirmation of level, disc excision and graft may be done. 13. For additional exposure of L4–L5, the level of the aortic