tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 38

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 38. 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. | 352 Section Surgical Approaches Figure 8. Surgical anatomy for left-sided thoraco-phrenico-lumbotomy a Landmark for skin incision. b Superficial dissection. c Dissection of the rib for resection see Fig. 6c . d The rib cartilage is split and marked with stay sutures. e The diaphragm is split about 2 cm medial to its rib insertion. f The medial and lateral crus of the diaphragm are transected and marked with stay sutures. The segmental vessels are ligated. The thoracic exposure is shown in Fig. 6d e. Surgical Approaches Chapter 13 353 section. After repair of the diaphragma the rib cartilage halves are refixed. The thorax is closed as described above. The abdominal wall is sutured in three separate layers transverse internal and external oblique muscles . Pitfalls and Complications A frequent complication is to accidently open the peritoneal sac during dissection of the diaphragma. This can be avoided when the preparation of the two body cavities is started from the abdominal site and the peritoneum freed from the diaphragma. When taking the diaphragma down to its insertion at the spine care has to be taken not to injure the greater splanchnic nerve ascending lumbar vein sympathetic trunk thoracic duct rarely visible during preparation A detailed discussion of the complications associated with this approach is included in Chapter 39 . Anterior-Lateral Retroperitoneal Approach to L2-L5 The anterior-lateral retroperitoneal approach to the lumbar spine has been an established operative technique since the early 1960s. This approach can be carried out also from the right side. The left sided approach however is favored because the inferior vena cava is less at risk. This approach is easy to perform even in obese patients because the abdomen is hanging to the side and the flank is exposed. Injuries to the thoracic duct can result in a chylothorax The anterolateral retroperitoneal lumbar approach is easily applicable even in obese patients Indications Indications for this