surgical know abouts Flashcards
what does ACDF stand for?
Anterior cervical discectomy and fusion.
What is a good thing about left approach in an ACDF?
The left recurrent laryngeal nerve is easier to avoid.
Where is the skinincision done for ACDF?
If transverse, over SCM. If multilayer, a longitudinal incision is better and put medial to SCM.
What are the risks of ACDF?
*Hoarse voice (recurrent laryngeal nerve)
*Esophagus injuries
*Carotid injuries
What is the first layer under the skin in ACDF?
Platysma.
What is under platysma and how should it be divided?
Its the deep cervical fascia. Divided along the anteromedial border of SCM.
What is the most important control to make after dividing the deep cervical fascia?
PALPATE THE CAROTID PULSE AND DISSECT MEDIAL TO THE CAROTID SHEAT
When you have the carotid sheat laterally of the dissection line, what is present medial of it?
Trachea and oesophagus and under them the prevertebral fascia.
What is done after dissecting bluntly down to the prevertebral fascia?
The trachea and oesophagus are pushed medially and the recurrent laryngeal nerve identified and protected.
what is the muscle called that is vizualised together with the vertebra under the fascia?
Its the longus colli muscle.
What is done after visualizing longus collis and the vertebra?
Level is verified w fluoroscopy, longus colli muscle is mobilized sidewise and distractors placed.
So, what are the structures to encounter from skin to disc in an ACDF?
- Skin
- Platysma
- Deep Cervical Fascia (SCM lateral to the incision through the fascia)
Obs! Before next step, carotid is palpated and made sure that it is situated laterally. - Trachea and Oesephagus (straight under) are pushed medially and next structure to encounter is the Prevertebral Fascia.
- Under the prevertebral fascia is the Vertebra and the Longus Colli muscle and usually superior to the longus collis, the recurrent laryngeal nerve is encountered on the right side.
Where is spinal EDH most commonly located and what is a surgical warrant?
Thoracic spine. Often associated to spine frx.
33% correlated to AK treatment.
Surgery should be done in case of neurological symtoms and then prompt. within 72h, prefereably 6h.
When should spinal SDH be treated surgically?
Only if more than minimal neurological deficits are seen.
What is the most common spinal cord inferction?
The anterior spinal artery - spare the posterior columns.
