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Home Neurosurgery Spine  Decompression T12-L1-2 C Pedicle Screw(PS) Fixation T12-L1-2 bilateral Lumbar fusion (PLF)
Decompression T12-L1-2 C Pedicle Screw(PS) Fixation T12-L1-2 bilateral Lumbar fusion (PLF)
2D
3D
Prof. Seong Yi Severance Hospital | Republic of Korea Speciality : Neurosurgery
57:26

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Published : 2019-05-17  Views : 276 Likes :
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Summary
Spinal decompression surgery (laminectomy) removes the compressive
structures, including hypertrophic ligamentum flavum and lumbar facet joint osteophytes.
The goals of surgical treatment are to alleviate neural compression and, in selected patients
with a deformity or instability, to stabilize the spine (fusion), so as to prevent further spinal
compression and recurrent symptoms.

Technique
- Dissection
Tissue planes are dissected along the spinous process and the laminae. Moving the
paraspinal muscles laterally provides visualization of the laminae, thereby enabling
exposure of the central canal and neural elements.

- Placement of Pedicle Screws
In selected patients (eg, those with a deformity or spondylolisthesis), a spinal fusion with
instrumentation is required. Spinal pedicle screws with connecting rods provide direct
fixation into the vertebrae and increase spinal stability, thereby improving the chances
of successful fusion. A successful spinal fusion requires osseous growth of the vertebrae
and the bone graft together.

- Intraoperative Fluoroscopy
Pedicle screws are localized by means of intraoperative fluoroscopy. The fluoroscopic
image in the slide shows that the pedicle screws are in proper position.

- Triggered Electromyography (EMG)
Intraoperative pedicle screw electrical stimulation is performed to confirm that the screws
are not compressing or in contact with the neural elements. This facilitates identification
and removal of the compression.

- Decompression
Decompression of the central canal and the neural structures is begun with the rongeur,
and the spinous process is removed.

- Confirmation of Screw Placement
Visual inspection of the incision shows that the L4 and L5 pedicle screws are in position
laterally and outside the canal.

- Rod Placement
After decompression is complete, rods are placed into the pedicle screws to stabilize the
spine, and set screws are tightened. Bone graft is placed laterally along the transverse
process to allow an osseous fusion.

- Closure
The retractors are removed and the decompression confirmed. The muscles are
then brought back together, and the fascia is closed. The cutaneous layers of the incision
are sutured closed.


Indications
- Deteriorating neurological status
- Caudal equina syndrome (Emergency)
- Compression of the cord is evident on MRI
- Penetrating cord injuries
- Gunshot injuries
- Bony fragments in the spinal canal
- Unstable vertebral body


Contraindications
- Severe Osteomalacia or Osteoporosis
- Vertebral Fractures
- Spondylolisthesis (Grade 2 or higher)
- Spondylolysis
- Unstable Post Surgical Conditions
- Any kind of surgical hardware
- Infection
- Ankylosing Spondylitis
- Dislocations, ligament tears or rupture
- Pregnancy
- Cauda Equina lesions
- Neurological defecits


Complications
- Pressure sores
- Pneumonia
- Osteoporosis & fractures
- Heterotrophic ossification
- Spastictiy
- Urinary tract infection
- Autonomic dysreflexia
- Deep venous thrombosis
- Orthostatic hypotension
- Thermal instability


Patient
Gender
Male

Age
48

■ Microscope : CarlZeiss Pentero

■ Navigation : Medtronic

■ Surgical Drill :    -

■ 3D Camera : 3DMedivision M-Flix

■ 3D Recorder : 3DMedivision R-Flix

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