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Spinal Surgery II > Cervical Disc Surgery > Flashcards

Cervical Disc Surgery Flashcards

1
Q

In cases of cervical disc herniation, what is the most common clinical sign?

A

neck pain

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2
Q

Are severe neuro signs more common with cervical or thoracolumbar disc hernia?

A

Thoracolumbar

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3
Q

In the cervical spine the disc space most often affected by disc extrusion is?

A

C2-C3

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4
Q

What will be the main indications for spinal surgery? (3)

A

Clinical signs are progressing or recurring

The patient has a poor response to conservative management

Pain is not controlled with the treatment.

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5
Q

What needs to be evaluated pre-operatively with spinal sx? (4)

A
  • Complete exam e.g. underlying dx, breed dx
  • Neuro grade
  • Basic blood (esp older!)
  • Imaging of thorax/abdo (if trauma)
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6
Q

What MUST be evaluated pre spinal surgery if traumatic?

A

Thora/abdo imaging

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7
Q

With spinal surgery, which breed needs extra GA monitoring?

A

Brachycephalic

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8
Q

Make sure all options and their potential complications are discussed with the owner. What needs to be discussed with the client? (4)

A

The prognosis and length of recovery

Surgical complications and post-surgical complications

Estimate costs

Written consent.

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9
Q

What determines the prognosis in terms of possible recovery, length of recovery and postoperative care required.

A

Neurological grading

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10
Q

Which surgical techniques can be used to remove herniated disc material in cases of cervical intervertebral disc disease? (3)

A

Ventral slot

Dorsal laminectomy

Hemilaminectomy

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11
Q

T or F:
NSAIDs should be administered in all patients with no gastrointestinal signs as these will provide analgesia and anti-inflammatory effect.

A

False

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12
Q

T or F:
Antibiotics should always be used peri-operatively and continued post-operatively.

A

False

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13
Q

T or F:
A combination of an opioid and acepromazine is a good option as pre-medication in a healthy patient.

A

True

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14
Q

T or F:
A urinary catheter should be placed in all patients.

A

True

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15
Q

What multi-modal analgesia should be used?

A

NSAIDs
Opiods
Gabapentin
Ketamine
Medetomodine

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16
Q

How would you identify the correct intervertebral disc space? (3)

A

By palpation of C6 wings (transverse processes)

Correctly checked
By palpation of the first rib head lateral to C7-T1 disc space

By palpation of C2 vertebral body, which is longer than the other vertebral bodies

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17
Q

What is the width of the ventral slot?

A

30-50% of the vertebral body

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18
Q

If the ventral slot is made bigger than 50%, what is the risk of this?

A

Subluxation

19
Q

How to select spinal burr size for ventral slot?

A

Measure the diameter of the ventral body (on X-rays/CT or MRI)

20
Q

How to position for a ventral slot?

A

Dorsal recumbency
Sand bag under neck

21
Q

What landmarks are used to ensure the neck position in a ventral slot?

A

manubrium and mandible

22
Q

When making a ventral slot incision; what landmarks?

A

larynx and manubrium

23
Q

What muscles need to be divided on the approach to ventral slot?
- What approach is required, followed by next muscle?

A

Sternohyoid m.

Caudal cervical approach; sternocephalicus m.

24
Q

Ventral slot; following a small incision in the fascia the small branches of what vein need to be cauterised?

A

Caudal thyroid v.

25
Q

Ventral slot;
Blunt dissect between the trachea and ?

A

Carotid sheath

26
Q

During a ventral slot; it is important to identify what structures? (4)

A

Oesophagus
Carotid sheath
Jugular vein
Recurrent laryngeal n.

27
Q

Ventral slot; Which retractors should be used to retract the trachea and oesophagus away from surgon?

A

Gossett

28
Q

What needs doing and which muscle to expose the ventral process in a ventral slot?

A

Divide the longus colli muscle cranial and caudal to the ventral process

29
Q

Ventral slot; What instrument aids the Divide of the longus colli muscle?

A

Periosteal elevator

30
Q

Ventral slot; what instrument is used to remove soft tissue surrounding disc space?

A

Rongeurs

31
Q

Ventral slot; what is used to fenestrate the disc?

A

Number 11 blade

32
Q

Ventral slot; where in relation to surgical slot is drilled?

A

Midline

33
Q

Ventral slot; if stay away from midline or if too long. What is this associated with? (2)

A

Instability
Fatal hemorrhage

34
Q

Ventral slot; important to keep flushing. When do you swap to a smaller burr?

A

Once onto the second cortical layer

35
Q

Where and how is the annulus fibrosus incised with a ventral slot?

A

On each side of the slot close to the bone with number 11 blade.

36
Q

Ventral slot; what is the slot floor excised with? (2)

A

Small rongeurs or a curette

37
Q

Ventral slot; after the disc material is removed; What should be visualised?

A

Dura mater

38
Q

Ventral slot; suture to close:
A) Longus colli muscles?

A

Vicryl

39
Q

Ventral slot; suture to close:
sternocephalicus and sternohyoid muscles?

A

PDS

40
Q

Ventral slot; suture to close:
Sub cut?

A

Monocryl

41
Q

Complication rate of a ventral slot?

A

10%

42
Q

Most common ventral slot complication?

A

Perioperative haemorrhage

43
Q

The most common complications of a ventral slot? (6)

A
  • Incorrect surgical site
  • Venous sinus bleed
  • Subluxation/instability due to large slot size
  • Redistribution of disc material
  • Impaired ventilation
  • Incomplete decompression.

Spinal Surgery II (7 decks)

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