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POSTERIORAPPROACHIntraoperativeCatastrophes(1-31)SpinalCordInjurySpinalcordinjury,wit...
POSTERIOR APPROACH
Intraoperative Catastrophes (1-31)
Spinal Cord Injury
Spinal cord injury, with resultant quadriplegia, tetraplegia, or paraplegia, can occur as a result of unwarranted attempts to remove disc fragments or spurs located along the anterior aspect of the spinal canal and nerve roots, or as a result of aggressive attempts to section dentate ligaments. Spinal cord injury can also result from too vigorous spinal cord retraction during intramedullary or other intradural procedures. Similarly, spinal cord injury caused by spinal cord compression or contusion can be brought on by the inadvertent penetration of an instrument into the spinal canal or by the rigorous placement of instruments into the spinal canal during bone removal, such as a wide laminectomy (reported risks, 0.4%).Finally, an increase in myelopathic compression and associated clinical symptoms can be seen as a result of turning the patient from the supine to the prone position with inadequate stabilization, or as a result of loosening the head immobilization device intraoperatively.
Major Vascular Injury
Laceration of the vertebral artery as it ascends over the lateral portion of Cl can occur quite easily in posterior approaches in this region. Venous bleeding encountered along the posterior lateral aspect of C2 or just anterior to the facet joints should alert the surgeon to the presence of the perivertebral venous plexus and its closely adjoining arterial structure, the vertebral artery.
Embolism with resultant cerebral ischemia occurring from procedures performed in the sitting position is a well-recognized phenomenon that requires immediate intraoperative recognition and treatment. The use of proper monitoring, including a right atrial catheter and Doppler, is essential (see Chapter 5). 展开
Intraoperative Catastrophes (1-31)
Spinal Cord Injury
Spinal cord injury, with resultant quadriplegia, tetraplegia, or paraplegia, can occur as a result of unwarranted attempts to remove disc fragments or spurs located along the anterior aspect of the spinal canal and nerve roots, or as a result of aggressive attempts to section dentate ligaments. Spinal cord injury can also result from too vigorous spinal cord retraction during intramedullary or other intradural procedures. Similarly, spinal cord injury caused by spinal cord compression or contusion can be brought on by the inadvertent penetration of an instrument into the spinal canal or by the rigorous placement of instruments into the spinal canal during bone removal, such as a wide laminectomy (reported risks, 0.4%).Finally, an increase in myelopathic compression and associated clinical symptoms can be seen as a result of turning the patient from the supine to the prone position with inadequate stabilization, or as a result of loosening the head immobilization device intraoperatively.
Major Vascular Injury
Laceration of the vertebral artery as it ascends over the lateral portion of Cl can occur quite easily in posterior approaches in this region. Venous bleeding encountered along the posterior lateral aspect of C2 or just anterior to the facet joints should alert the surgeon to the presence of the perivertebral venous plexus and its closely adjoining arterial structure, the vertebral artery.
Embolism with resultant cerebral ischemia occurring from procedures performed in the sitting position is a well-recognized phenomenon that requires immediate intraoperative recognition and treatment. The use of proper monitoring, including a right atrial catheter and Doppler, is essential (see Chapter 5). 展开
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后路
术中灾害(1 - 31)
脊髓损伤
脊髓损伤、其quadriplegia,tetraplegia,或为截瘫,可能出现由于莫须有的试图拆卸阀瓣碎片与马刺分布在前的方面,神经根椎管内,或因积极试图部分齿状韧带受伤了。脊髓损伤还可能是因为太蓬勃脊髓回缩在髓内或其他硬膜内程序。同样,脊髓损伤引起脊髓压迫或挫伤可能导致的渗透无意产生一种到椎管内,或将以严谨的放置乐器带上椎管内,如在骨切除大至0.4%(报风险,增加。最后,myelopathic压缩及相关的临床症状可以被看作是由于把患者仰卧位的不足和成俯卧姿势稳定、或因用餐后立即松开头固定装置以参考。
主要血管损伤
撕裂椎动脉走行变异的,因为它提升在侧部分很容易就会发生实习后方法在该区域。在遇到静脉出血后侧面C2或只是时期以前的胸椎小关节外科医生应该警示的存在,perivertebral静脉丛紧密相邻的动脉结构、椎动脉。
栓塞其时不时会出现的脑缺血的手术在坐立性交姿势现象已需要立即术中识别和治疗。使用进行适当的监控,包括右心房导管和多普勒,是十分必要的(看第5章)。
术中灾害(1 - 31)
脊髓损伤
脊髓损伤、其quadriplegia,tetraplegia,或为截瘫,可能出现由于莫须有的试图拆卸阀瓣碎片与马刺分布在前的方面,神经根椎管内,或因积极试图部分齿状韧带受伤了。脊髓损伤还可能是因为太蓬勃脊髓回缩在髓内或其他硬膜内程序。同样,脊髓损伤引起脊髓压迫或挫伤可能导致的渗透无意产生一种到椎管内,或将以严谨的放置乐器带上椎管内,如在骨切除大至0.4%(报风险,增加。最后,myelopathic压缩及相关的临床症状可以被看作是由于把患者仰卧位的不足和成俯卧姿势稳定、或因用餐后立即松开头固定装置以参考。
主要血管损伤
撕裂椎动脉走行变异的,因为它提升在侧部分很容易就会发生实习后方法在该区域。在遇到静脉出血后侧面C2或只是时期以前的胸椎小关节外科医生应该警示的存在,perivertebral静脉丛紧密相邻的动脉结构、椎动脉。
栓塞其时不时会出现的脑缺血的手术在坐立性交姿势现象已需要立即术中识别和治疗。使用进行适当的监控,包括右心房导管和多普勒,是十分必要的(看第5章)。
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后路
术灾难(1-31)
脊髓损伤
脊髓损伤,四肢瘫痪的结果,四肢瘫痪,或截瘫,可能会出现作为一种无理企图取出光盘片段结果或马刺沿着脊髓及神经根管,前方面或一个积极的尝试结果位于第齿状韧带。脊髓损伤也可能来自于太大力或其他期间髓内脊髓硬膜程序回缩。同样,脊髓损伤脊髓压迫或挫伤可以带来由文书进入椎管或无意渗透的文书进入椎管严格搬迁安置,如在骨宽椎板切除术,(报告风险,0.4%)。最后,在myelopathic压缩和相关的临床症状加重,可作为转向病人从仰卧到俯卧位不足的稳定,或由于头部的固定装置松动术的结果来看。
大血管损伤
椎动脉裂伤上升,因为它可以发生在这个地区后路很容易对氯外侧部分。沿静脉出血后遇到C2的侧面或只是眼前的小关节外科医师应警惕到perivertebral静脉丛,其结构紧密相连动脉,椎动脉的存在。
由此产生的脑与从坐位执行的程序发生缺血栓塞是大家公认的现象,需要立即手术的识别与处理。在使用适当的监测,包括右心房导管和多普勒,是必不可少的(见第五章)。
术灾难(1-31)
脊髓损伤
脊髓损伤,四肢瘫痪的结果,四肢瘫痪,或截瘫,可能会出现作为一种无理企图取出光盘片段结果或马刺沿着脊髓及神经根管,前方面或一个积极的尝试结果位于第齿状韧带。脊髓损伤也可能来自于太大力或其他期间髓内脊髓硬膜程序回缩。同样,脊髓损伤脊髓压迫或挫伤可以带来由文书进入椎管或无意渗透的文书进入椎管严格搬迁安置,如在骨宽椎板切除术,(报告风险,0.4%)。最后,在myelopathic压缩和相关的临床症状加重,可作为转向病人从仰卧到俯卧位不足的稳定,或由于头部的固定装置松动术的结果来看。
大血管损伤
椎动脉裂伤上升,因为它可以发生在这个地区后路很容易对氯外侧部分。沿静脉出血后遇到C2的侧面或只是眼前的小关节外科医师应警惕到perivertebral静脉丛,其结构紧密相连动脉,椎动脉的存在。
由此产生的脑与从坐位执行的程序发生缺血栓塞是大家公认的现象,需要立即手术的识别与处理。在使用适当的监测,包括右心房导管和多普勒,是必不可少的(见第五章)。
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是 后路
术中灾害(1 - 31)
脊髓损伤
脊髓损伤、其quadriplegia,tetraplegia,或为截瘫,可能出现由于莫须有的试图拆卸阀瓣碎片与马刺分布在前的方面,神经根椎管内,或因积极试图部分齿状韧带受伤了。脊髓损伤还可能是因为太蓬勃脊髓在髓内或其他intradura缩
术中灾害(1 - 31)
脊髓损伤
脊髓损伤、其quadriplegia,tetraplegia,或为截瘫,可能出现由于莫须有的试图拆卸阀瓣碎片与马刺分布在前的方面,神经根椎管内,或因积极试图部分齿状韧带受伤了。脊髓损伤还可能是因为太蓬勃脊髓在髓内或其他intradura缩
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