Safe Orthopaedic Surgery by S. Venkatesh Babu

Author:S. Venkatesh Babu
Language: eng
Format: epub
ISBN: 9789811628467
Publisher: Springer Singapore

Surgical site markings

Verification of the spine pathology level during operation using radiography

When executed watchfully and by the book, cervical spine surgery can be successful and have a low rate of untoward incidences. The surgeon’s alertness must extend from induction of the anaesthesia and patient positioning to meticulous dissection and instrumentation techniques—that is, the entire procedure. In anterior surgery, prolonged and forceful retractions is to be avoided to preventi injury to the esophagus, recurrent laryngeal nerve, and carotid arteries. Further protection of corpectomies with plating combined with posterior spinal fusion and instrumentation will reduce the incidences of graft dislodgments. Careful selection of patients for corpectomy is the key factor since graft collapse and subsidence commonly occurs with osteopenic bone. In posterior surgery, prophylactic foraminotomy will reduce the risk of C5 nerve root palsy. Spinal cord monitoring should occur in all cases of cervical spine surgery. A very cautious analysis of the bony and vascular anatomy is to be done preoperatively, especially when internal fixation is planned. Preservation of posterior muscle and their attachments is vital for prevention of postoperative neck pain and delayed kyphosis.

Most complications are avoidable with sufficient preparation. Applying principles of antisepsis will prevent surgical site infection. Complications of spine surgery can sometimes be difficult to diagnose, and it is also frequently difficult to identify the reasons of recurrent symptoms on clinical grounds alone. Radiography is the benchmark follow-up imaging method [3, 6].

References

1.

Proietti L, Scaramuzzo L, Schiro GR et al (2013) Complications in lumbar spine surgery: a retrospective analysis. Indian J Orthop 47(4):340–345Crossref

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