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Now is its revised and improved 3rd variation, together with 9 new chapters, this step by step, cutting-edge procedural guide covers over 50 special surgical techniques for accidents and prerequisites of the backbone. Generously illustrated, a variety of surgical techniques to the cervical, thoracic and lumbar backbone are essentially enumerated and defined, together with anterior, lateral, and posterior methods and the global stream towards using tubular retractors for a large number of ways. Written and edited through leaders within the box of backbone surgical procedure, this up to date variation may be a useful source for orthopedic surgeons, neurosurgeons and activities medication practitioners alike.
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Additional resources for Surgical Approaches to the Spine (3rd edition)
Example text
It crosses through the carotid triangle, arches deep to the strap muscles, and enters the lateral superior aspect of the thyroid gland. Retract the superior thyroid artery and vein inferiorly (Fig. 2). 9. Identify and retract the hypoglossal nerve (Fig. 3). The hypoglossal nerve is found passing from lateral to medial superficial to the external carotid, lingual, and facial arteries. The hypoglossal nerve exits the skull in close proximity to the vagus nerve and courses between the internal carotid artery and internal jugular vein, becoming superficial at the angle of the mandible.
More recently, we have used a per entral gastrotomy tube (PEG) passed 2 to 3 days before the operation. Surgery Positioning and Instrumentation The lateral position with the head held in a Mayfield retractor [8] confers several advantages. Blood and washings drain away from the operative site, the operator may be seated and comfortable for an exacting procedure, and it is possible to perform an anterior decompression and a posterior fixation with the patient fixed in one position, minimizing risks to the neuraxis.
During medial retraction of the internal jugular vein and carotid sheath, remember the origin and location of the vagus and hypoglossal nerves. Although the vagus nerve enters the carotid sheath cephalad to C2 and should be retracted with the sheath, if it does appear to be a direct tether to medial retraction, dissect it distally from the sheath. The hypoglossal nerve may be exposed but should easily retract medially. The internal jugular vein is in a vulnerable position with medial anterior retraction of the carotid sheath and should be protected in the approach.