Percutaneous anterior cervical disc herniated nucleus pulposus resection

Cervical anterior approach for cervical disc herniation was first reported by Cloward (1958). The company developed a surgical instrument that is safe and suitable. In the treatment of large cases, the efficiency is over 90%, which is more common in international applications. In the 1960s, China carried out this method of surgery, and there were many units applied. In the same year as Cloward reported, Smith and Robinson also reported anterior surgery for cervical spondylosis, emphasizing bone graft fixation without removing the osteophytes that oppress the spinal cord. Later, some authors used the Smith Robinson method for cervical disc herniation. Some authors believe that postoperative bone graft fusion is not effective. Treatment of diseases: cervical disc herniation Indication Percutaneous anterior cervical disc herniation is applicable to: 1. Head and neck trauma, quadriplegia immediately after injury, no cervical spine fracture or fracture dislocation through cervical X-ray, no cervical hyperplasia, and myelography, CT myelography or MRI confirmed cervical disc herniation. 2. Light head and neck injury, numbness and weakness of the limbs, symptoms develop slowly, cervical spine X-ray examination without fracture, dislocation, no bone hyperplasia, myelography or MRI examination confirmed the disease. Contraindications 1. In the late stage of cervical spinal cord compression, if the pressure is below the plane for more than half a year, the operation may not restore hope. 2. Lateral cervical disc herniation of shoulder and shoulder pain, although the absolute contraindication for anterior surgery, but the anterior approach is more invasive, more complications, better surgery in the future. Preoperative preparation Skin and instrument preparation for bone removal on one side of the tibia. Surgical procedure Neck incision In the plane of the fractured vertebral body, from the anterior cervical line to the left or right sternocleidomastoid anterior border, the left or right transverse incision is 6-8 cm long, and the recurrent laryngeal nerve can be less pulled when the left incision is made. . The incisions are peeled up and down along the subcutaneous tissue, respectively. 2. Reveal the front of the vertebral body The platysma and deep fascia were cut along the anterior border of the sternocleidomastoid, and the sternocleidomastoid and carotid sheath were pulled to the outside; the thyroid, trachea and esophagus were pulled to the medial side. Often thyroid venous obstruction is revealed and can be sheared after electrocoagulation or ligation. The loose connective tissue is peeled off to the deep part, and the finger can touch the front of the cervical vertebra in the middle line, revealing 3 to 4 vertebral bodies. At this point, the automatic retractor can be replaced, taking care not to damage the esophagus. In the 3~4 plane of the neck, the superior thyroid artery and the superior laryngeal nerve can be encountered, and the upper thyroid artery should be cut off when the 2~3 intervertebral space of the neck is exposed. In the 7-plane of the neck, the inferior thyroid artery and the recurrent laryngeal nerve can be encountered. Carefully pull it down and do not damage the recurrent laryngeal nerve. 3. Vertebral body positioning Generally, after the front of the vertebral body is exposed, two syringe needles are applied, respectively, and the depth of the intervertebral space and the adjacent intervertebral space are respectively penetrated to a depth of 1.5 cm. If the depth is too deep, there is a risk of stabbing the cervical spinal cord. The X-ray cervical lateral radiograph is taken next to the operating table, and after the wet film is washed out, the vertebral body and the upper intervertebral space can be determined. 4. Intervertebral space drilling Centering on the upper intervertebral space of the fractured vertebral body, the anterior longitudinal ligament in front of the two cervical vertebrae is valvularly cut and turned to one side. Before the cervical spine is drilled, the adjacent vertebral body part of the intervertebral space is scheduled to be drilled into a metal retaining ring with 4 studs, and then a vertical hollow cylinder is connected to ensure that the drill bit is not drilled. Slip off or tilt. The Cloward-type adjustable depth round drill is placed in the hollow cylinder and the retaining ring, and the vertebral body is drilled in the front direction. Generally, the anteroposterior diameter of the cervical 3 to 7 vertebral body is 16 to 23 mm. Therefore, after drilling 15mm, the round drill should be withdrawn every 1mm, and the bottom of the drill hole should be inspected at the end of the stripper or the suction head. If the thin cortical bone behind the vertebral body is found to be vibrating or exposed. The posterior longitudinal ligament, that is, the drill should be terminated to avoid deep damage to the dura mater and spinal cord tissue. 5. Nucleus pulpectomy When the Cloward method is used to drill the posterior margin of the vertebral body, only a thin layer of cortical bone remains, and most of the intervertebral disc tissue in the intervertebral space is removed. 6. Interbody fusion When the Cloward method is applied, the bone column is taken from the tibia with a trephine, and the interbody fusion is performed. If the Smith Robinson method is applied, there are two options for iliac bone fusion or non-bone fusion. 7. Suture incision The cervical spine was drained in front of the silicone tube. The deep fascia, platysma, subcutaneous tissue and skin are sutured layer by layer. complication 1. Postoperative hematoma. The swelling of the operation should be closely observed within 1 to 2 days after the operation. If it is found that the breathing is difficult and the local hematoma is suspected, the wound should be opened quickly for treatment. 2. Postoperative neurological symptoms worsened. The cause should be analyzed. If there is bleeding or the sacral column is inserted into the deep compression spinal cord, surgery should be performed again. 3. The bone column is prolapsed. When affecting hypopharyngeal function, re-implantation should be taken out. 4. The sound is low and hoarse. Intraoperative injury caused by laryngeal and recurrent laryngeal nerve. The superior laryngeal nerve is accompanied by the vagus nerve and is accompanied by the superior thyroid artery. It enters the larynx to innervate the inferior pharyngeal muscle, the ring muscle and the laryngeal mucosa. After the injury, the sound is low and thick, and the throat has no sensation. The recurrent laryngeal nerve is adjacent to the thyroid gland. The artery moves upwards in the outer edge of the trachea and esophageal sulcus, and enters the larynx to control the movement of the vocal cords. The vocal cords on one side are paralyzed and hoarse. Therefore, the surgeon must be familiar with the vagus nerve and the two major branches of the walking and anatomical relationship, when separating and cutting the upper and lower thyroid artery must pay attention to protect the two nerves, such as due to the retractor tension and excessive hoarseness, should be hoarse Relax the retractor.

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