Decompression and decompression of the lateral wall resection of the spinal canal

Spinal wall debridement debridement is a medical term that applies to patients with thoracic and thoracolumbar spine problems. Treating diseases: spinal tuberculosis Indication Thoracic and thoracolumbar spine tuberculosis has one of the following conditions: 1. With paraplegia, X-ray film, CT or MRI symptoms or estimated dead bone or necrotic tissue and other protrusions into the spinal canal. 2. Lumbar puncture Quebec test showed obstruction. 3. The lesion is located behind the vertebral body and there is difficulty in clearing the lateral anterior approach. 4. The kyphosis of the vertebral body is severe, and the posterior margin of the vertebral body forming an acute angle compresses the spinal cord. Preoperative preparation 1. Acquire patient cooperation: Bone and joint tuberculosis is a chronic disease with a long course of treatment and often has a certain degree of dysfunction after treatment. Therefore, most patients have irritable mood and ideological burden. Before the operation, we must thoroughly explain the work, and truthfully seek the treatment plan and consequences (including the number of operations, external fixation and bed time, medication time and possible dysfunction) to the patient and their families to obtain cooperation. 2. Perform the necessary examinations: Careful examination and chest fluoroscopy should be performed before surgery to find out if there are other tuberculosis lesions in the body. For patients with long disease period and many sinus secretions, liver and kidney function should be checked. X-ray examination should be performed on the lesions. If necessary, spinal tuberculosis and paraplegia should be performed by CT examination to understand the lesions for surgery. Surgical procedure 1. Position: Generally, the vertebral body destruction is more serious, the dead bone is more, the paraspinal abscess is larger, and the side with heavier paraplegia is used as the operation side. The position was the same as that of the rib and transverse process, and the lateral position was placed on the lateral side. 2. Exposing and clearing vertebral lesions: If you take the transthoracic approach, you can refer to the surgical procedure for transthoracic tuberculosis. For example, if the posterior approach is taken, the incision is the same as clearing the tuberculosis by ribs and transverse processes. Only the median line or the curved incision should be made close to the posterior midline to expand the exposure, resection of the articular process and lamina. The length of the incision exceeds the upper and lower vertebral bodies of the diseased vertebra. If necessary, the sacral spine muscle can be cut off to fully reveal it. Generally, the two posterior ribs and transverse processes are removed first. If the lesions are extensive, 3 to 4 can be removed. The intercostal nerve is separated at the lower edge of the rib, which is ligated, cut, and turned to the opposite side. Pushing open the pleura and revealing the sides and front of the vertebral body can remove the vertebral lesions. After the removal is completed, the gauze is temporarily blocked to stop bleeding. 3. Excision of the vertebral arch: Separate along the midline of the intercostal nerve to the midline, find the intervertebral foramen, and first remove 1 to 2 pedicles adjacent to the lesion. Generally, the spinal tuberculosis products are pressed backwards between the adjacent two diseased vertebrae, and the vertebral pedicle of the next disease is removed, which can be revealed. However, due to the different extent of vertebral body destruction, the compression parts such as dead bone and granulation are different, especially tuberculous granuloma can spread up and down. Therefore, it is necessary to remove the upper and lower pedicles to enlarge the exposure. When the root is removed, the vertebral plate rongeur can be used to extend into the spinal canal and gradually bite. 4. Spinal canal exploration and decompression: After the pedicle is removed, the operating table is shaken so that the patient's back is at an angle of 60° to the ground. Gently pull the intercostal nerve, and use the dura stripper to separate the lateral and anterior sides of the dura mater along the nerve to scrape off the granulation tissue. Re-inserted into the dura mater, gently pull back and to the opposite side to protect the spinal cord. At this point, the spinal canal can be explored to clarify the cause of the cause. Common causes are dead bone or necrotic disc tissue compression, which should be completely removed and relieved under direct vision until the hard ridge hard recovery beats, and then continue to examine and clear the lesions of the posterior vertebral body. If the dural pulsation does not recover, it should be considered that there is still compression, mostly caused by granulation and pus up and down. The upper and lower pedicles or part of the articular processes or lamina should be removed to fully reveal the lesions. Then use a thin catheter to extend up and down the spinal canal for exploration. If there is no obstruction, the operation can be stopped. If it is found that the spinal cord is compressed due to the acute angle of the posterior margin of the vertebral body, special attention should be paid to the incision of the osteotome, so as to prevent the bone from protruding into the spinal canal. A small chisel piece is used to remove or first scrape the cancellous bone of the posterior margin of the subcortical vertebral body, leaving a gap, and then pressing the acute angle of the cortical bone into the space, and then removing the cortex. After the removal of the side wall of the spinal canal, the stability of the spine will be weakened, and the interbody fusion can have a certain supporting effect and promote healing. Internal fixation should be added to the enlargement of the enlarged side wall of the spinal canal. If the paraplegia does not recover after surgery, interbody fusion can also create conditions for the second resection of the lamina. The bone grafting procedure was performed by removing the TB lesions through the ribs and transverse processes. 5. Stitching: After clearing the lesion and relieving the spinal cord compression, the wound is thoroughly washed with physiological saline. The lesion is filled with streptomycin powder 1g, and the gauze jammed in the wound is taken out, and then sutured layer by layer without drainage.

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