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Home Neurosurgery Spine Surgery  Posterior Discectomy c Foraminotomy C5-6-7 c Total Removal of Tumor T1,Rt

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Posterior Discectomy c Foraminotomy C5-6-7 c Total Removal of Tumor T1,Rt
2D
3D
Prof. Seong Yi Severance Hospital | Republic of Korea Speciality : Neurosurgery
44:06

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Published : 2019-05-17  Views : 156 Likes :
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Information

Summary
The goal of surgery for a cervical herniated disc is to remove the damaged disc and ensure
that the nerve root and/or spinal cord is decompressed.


Posterior cervical discectomy
A small incision is made in the midline of the back of the neck. The para-spinal muscles
are elevated off the spinal level that is to be approached. An x-ray is done to confirm that
the surgeon is at the correct level of the spine. A high-speed burr is used to remove some
of the facet joint, and the nerve root is then identified under the facet joint. An operating
microscope is then used for better visualization. The disc will be directly under the nerve
root, which needs to be gently mobilized (moved to the side) to free up the disc herniation.
There is usually a plexus (network) of veins over the disc that can obstruct visualization
if they bleed.


Foraminotomy
A foraminotomy is a decompression surgery that is performed to enlarge the passageway
where a spinal nerve root exits the spinal canal. The term foraminotomy is derived from
the medical term for a hollow passageway—foramen. The latter half of the term
foraminotomy—otomy—means to open. The procedure can be performed as a day
stay surgery, but most patients stay in hospital for 1-2 nights. General anesthesia is
utilized and the surgery is performed through an incision of 2-4 cm. Usually a small window
is made on one side of a spinous process, at the junction of the lamina and facet joint,
through the removal of some bone and ligament to allow visualization of the involved root.
Using a high speed drill and microinstruments, once the nerve root affected is identified,
the whole out of which the nerve passes is enlarged. The nerve root is then gently elevated
and if there is a disk bulge this is palpated. If identified, the disk bulge is incised and
typically a tiny piece of disk is removed. The whole disk is not removed. The operation is
then complete and after placing cortisone over the nerve root, closure is effected, typically,
with dissolving sutures for skin. Typically this takes 1-2 hours to perform.


Total Removal of Tumor
Surgery is performed in order to improve patient outcome, reduce the risk of paralysis and
reduce pain, tumors of the bony spinal column may require resection and stabilization.
Spinal Tumor surgery is generally indicated in case there is a localized tumor which can
be removed with minimum damage to nerve and spinal cord. There is persistent
neurological deficit and pain which is unresponsive to non operative treatment Surgery
may include resection or excision of tumor.


Approach
- Posterior keyhole approach **
- Anterior approach


Indications
Discectomy & Foraminotomy
- Nerve root compression (Spinal stenosis, Degenerative disc disease, a bulging or
  herniated intervertebral disc, bone spurs, spondylosis)
- If the pain lasts longer than 6 to 12 weeks, or if the pain and disability are severe and
  unresponsive to nonsurgical treatments

Tumor removal
The surgery will depend on symptoms.
- Back pain often radiating to other body parts
- Difficulty walking
- Loss of sensation or muscle weakness
- Loss of bowel/bladder function
- Scoliosis
- Desturction of vertebral body
- Paralysis of varying degree


Warning Signs
- Bleeding
- Infection
- Dural leak


Complications
- Nerve root injury
- Spinal cord injury
- Continued Neck pain
- Recurrent disc herniation


Patient
Gender
Male

Age
57

Chief Complaint
Rt. arm pain, Post neck pain

Diagnosis
C5-6-7 Rt (HCD) with foraminal stenosis spinal cord tumor T1 IDEM, Schwannoma

■ Microscope : CarlZeiss Pentero

■ Navigation : Medtronic

■ Surgical Drill :    -

■ 3D Camera : 3DMedivision M-Flix

■ 3D Recorder : 3DMedivision R-Flix
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