Cervical Spine Laminectomy + Lateral Mass Screw Fusion neurosurgeon animations

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• published: 08 Jul 2011
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http://www.medilaw.tv - Cervical Spine Laminectomy + Lateral Mass Screw Fusion neurosurgeon animations. A Laminectomy is a procedure that removes some lamina and spinal processes at the back of the spinal canal to increase the space for, and decrease the pressure on, the spinal cord. INTRODUCTION An atlanto-axial trans-articular screw fusion is done to realign and stabilize the first and second cervical vertebra. During the procedure, bone graft is sometimes placed between the two vertebrae. This bone graft will fuse over three months to turn the two vertebrae into one solid bone. While the bone is fusing it is held still by two metal screws and wiring or rods. Due to variations in bone and vertebral artery anatomy, twenty percent of clients can only have the screw placed on one side, or need to have the fusion extended to another level. This does not usually affect the final outcome. Cervical Spine Laminectomy + Lateral Mass Screw Fusion neurosurgeon animations. INDICATIONS If diseased or fractured bone or damaged joints in the top two vertebrae in the neck are causing neck pain or placing pressure on the spinal cord or the nerve roots leaving the spinal cord, and causing pain, weakness or numbness in the arms or legs, then surgery is indicated. Common reasons for an atlanto-axial fusion are inflammatory diseases such as rheumatoid arthritis, traumatic fracture with non-union, tumor or congenital malformations. ALTERNATIVES The non-surgical alternatives to cervical fusion may be – hard collar or ‘halo’ immobilization – activity modification – weight loss – aerobic exercise, such as walking, cycling, and swimming – strength and flexibility exercises – physical therapy – hydrotherapy – heat and cold pads – acupuncture – pain-relieving medications such as acetaminophen or paracetamol, non-steroidal anti-inflammatory drugs, glucosamine, chondroitin The surgical alternatives to cervical fusion may be – steroid and local anesthetic injections – disc replacement surgery, or arthroplasty. Cervical Spine Laminectomy + Lateral Mass Screw Fusion neurosurgeon animations. INFORMED REFUSAL It is your right to delay or refuse the recommended treatment for your condition. However, this delay or refusal may lead to the worsening of your symptoms, such as increased arm pain, pins and needles, weakness or numbness. You should ask your doctor what might happen should you chose not to undertake the recommended treatment. BEFORE Before the atlanto-axial fusion - a doctor will perform a medical examination and any necessary tests to ensure that your general health will permit an anesthetic to be given and the procedure to be performed - you will be advised when to stop any medications that will increase your bleeding risk ie aspirin, non-steroidal anti-inflammatories, anti-coagulants, vitamin E, glucosamine and some herbal medicines (including chamomile, danshen, garlic, gingko, devil’s claw, ginseng, fish oil, willow bark, feverfew, goji berries) - you may be admitted into the hospital on the day before or on the morning of the procedure - don't eat or drink anything for six hours before the procedure - wear loose-fitting clothes that are easy to take off and put on. Do not wear any jewelry. - before the procedure, the skin on your neck will be cleaned and you will be given a general health check. The skin on your neck may be shaved. - an intra-venous line will be placed in to a vein in your arm to administer fluid and medications - you may be given a sedating medication to make you drowsy before being given your anesthetic - you will be given a general anesthetic that will put you to sleep - let your doctor know if you develop a fever, cold or flu symptoms before your scheduled procedure GOALS The goals of a cervical fusion are to stabilize the spine and remove compression of the adjacent spinal cord. This should lead to improved function and less pain. The implants provides immediate stability while the bony fusion occurs over the following three to twelve months. TECHNIQUE Cervical Spine Laminectomy + Lateral Mass Screw Fusion neurosurgeon animations. You will be lying on your front. Your neck will be cleaned. An incision will be made in the middle of the neck and the overlying muscles will be moved to the side. A small incision will be made at the base of the neck and a guide tube will be inserted up to the second cervical vertebra. A guide pin will be advanced into the second and first vertebra. A screw hole will be drilled and a thread will be tapped. Then the screw will be inserted. This will be repeated on the other side. A bone graft may be tied between the two vertebrae to fuse them together and help secure the fixation. Bone chips may be added to further assist this fusion. X-rays and intra-operative computerized navigation will be used to check the position of the screws and bone graft. The muscles will be replaced and the wounds closed with sutures. NO SMOKING Smoking damages e