Cervical Disc Surgery Flashcards
In cases of cervical disc herniation, what is the most common clinical sign?
neck pain
Are severe neuro signs more common with cervical or thoracolumbar disc hernia?
Thoracolumbar
In the cervical spine the disc space most often affected by disc extrusion is?
C2-C3
What will be the main indications for spinal surgery? (3)
Clinical signs are progressing or recurring
The patient has a poor response to conservative management
Pain is not controlled with the treatment.
What needs to be evaluated pre-operatively with spinal sx? (4)
- Complete exam e.g. underlying dx, breed dx
- Neuro grade
- Basic blood (esp older!)
- Imaging of thorax/abdo (if trauma)
What MUST be evaluated pre spinal surgery if traumatic?
Thora/abdo imaging
With spinal surgery, which breed needs extra GA monitoring?
Brachycephalic
Make sure all options and their potential complications are discussed with the owner. What needs to be discussed with the client? (4)
The prognosis and length of recovery
Surgical complications and post-surgical complications
Estimate costs
Written consent.
What determines the prognosis in terms of possible recovery, length of recovery and postoperative care required.
Neurological grading
Which surgical techniques can be used to remove herniated disc material in cases of cervical intervertebral disc disease? (3)
Ventral slot
Dorsal laminectomy
Hemilaminectomy
T or F:
NSAIDs should be administered in all patients with no gastrointestinal signs as these will provide analgesia and anti-inflammatory effect.
False
T or F:
Antibiotics should always be used peri-operatively and continued post-operatively.
False
T or F:
A combination of an opioid and acepromazine is a good option as pre-medication in a healthy patient.
True
T or F:
A urinary catheter should be placed in all patients.
True
What multi-modal analgesia should be used?
NSAIDs
Opiods
Gabapentin
Ketamine
Medetomodine
How would you identify the correct intervertebral disc space? (3)
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
What is the width of the ventral slot?
30-50% of the vertebral body
If the ventral slot is made bigger than 50%, what is the risk of this?
Subluxation
How to select spinal burr size for ventral slot?
Measure the diameter of the ventral body (on X-rays/CT or MRI)
How to position for a ventral slot?
Dorsal recumbency
Sand bag under neck
What landmarks are used to ensure the neck position in a ventral slot?
manubrium and mandible
When making a ventral slot incision; what landmarks?
larynx and manubrium
What muscles need to be divided on the approach to ventral slot?
- What approach is required, followed by next muscle?
Sternohyoid m.
Caudal cervical approach; sternocephalicus m.
Ventral slot; following a small incision in the fascia the small branches of what vein need to be cauterised?
Caudal thyroid v.
Ventral slot;
Blunt dissect between the trachea and ?
Carotid sheath
During a ventral slot; it is important to identify what structures? (4)
Oesophagus
Carotid sheath
Jugular vein
Recurrent laryngeal n.
Ventral slot; Which retractors should be used to retract the trachea and oesophagus away from surgon?
Gossett
What needs doing and which muscle to expose the ventral process in a ventral slot?
Divide the longus colli muscle cranial and caudal to the ventral process
Ventral slot; What instrument aids the Divide of the longus colli muscle?
Periosteal elevator
Ventral slot; what instrument is used to remove soft tissue surrounding disc space?
Rongeurs
Ventral slot; what is used to fenestrate the disc?
Number 11 blade
Ventral slot; where in relation to surgical slot is drilled?
Midline
Ventral slot; if stay away from midline or if too long. What is this associated with? (2)
Instability
Fatal hemorrhage
Ventral slot; important to keep flushing. When do you swap to a smaller burr?
Once onto the second cortical layer
Where and how is the annulus fibrosus incised with a ventral slot?
On each side of the slot close to the bone with number 11 blade.
Ventral slot; what is the slot floor excised with? (2)
Small rongeurs or a curette
Ventral slot; after the disc material is removed; What should be visualised?
Dura mater
Ventral slot; suture to close:
A) Longus colli muscles?
Vicryl
Ventral slot; suture to close:
sternocephalicus and sternohyoid muscles?
PDS
Ventral slot; suture to close:
Sub cut?
Monocryl
Complication rate of a ventral slot?
10%
Most common ventral slot complication?
Perioperative haemorrhage
The most common complications of a ventral slot? (6)
- Incorrect surgical site
- Venous sinus bleed
- Subluxation/instability due to large slot size
- Redistribution of disc material
- Impaired ventilation
- Incomplete decompression.
