tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 37

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 37. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 342 Section Surgical Approaches Identify and regularly check the pulsation of the carotid artery level localization. The structures at risk during this approach have been listed above. A deleterious pitfall is the risk of unintentionally retracting the carotid artery medially instead of laterally. Therefore the pulse of this artery must be palpated to ensure that the artery is indeed lateral. The overall risk of operative complications remains small but significant 72 . In 450 cases of anterior cervical discectomy the rates of recurrent nerve palsy and Horner s syndrome were and respectively 9 . However the true rate of nerve root injury based on laryngoscopy is substantially higher 24 34 . Apfelbaum suggested monitoring endotracheal tube ET cuff pressure and release of the pressure after retractor replacement or repositioning has been used which enables the ET to be recentered within the larynx 4 . The natural history of a recurrent nerve lesion is benign 34 . Complete recovery of vocal cord function was documented in 26 93 of 28 patients who had undergone a thyroidectomy 46 . Dysphagia is a not uncommon problem after anterior cervical spine surgery. Overall the incidence of dysphagia 2 years after anterior cervical spine surgery was based on the analysis of 348 cases 43 . Risk factors for long-term dysphagia after anterior cervical spine surgery include gender revision surgery and multilevel surgery. The use of instrumentation higher levels or corpectomy versus discectomy did not significantly increase the prevalence of dysphagia 43 . Vertebral artery injury is a rare complication in cervical discectomy 10 . However in a report on 185 corpectomies the vertebral artery was injured in four patients 18 . Posterior Approach to the Cervical Spine The anterior and posterior approaches are both frequently used to approach the cervical spine in a variety of disorders 58 . However usually the anterior approach is preferred because of the minimal .

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