頚椎神経根を圧迫する椎間板ヘルニア摘出の瞬間です。
ズルズルっと引っ張り出せました。
手術直後から首肩腕の痛みが消失しています。
頚椎C6/7の右外側型ヘルニアの手術動画です。
術式：顕微鏡下頚椎前方椎間孔拡大術（マックF）というキーホール手術です。
術者：土屋直人（品川志匠会病院）
For those undergoing Microsurgical Anterior Cervical Foraminotomy (MacF)
Naoto Tsuchiya, M.D.
Neurosurgeon
Shinagawa Shisyokai Hospital
Kitashinagawa 1-29-7
Shinagawa Tokyo Japan
140-0001
Tel:81-3-5781-0700
Fax:81-3-5781-0828
What is Microsurgical Anterior Cervical Foraminotomy (MacF)？
The cervical spine contains the spinal cord, and 8 pairs of cervical nerve roots which control the movement and sensation of both arms and hands. Symptoms, such as pain, numbness, and tingling of shoulders, arms, and hands, are induced by compression of misplaced cartilage (disc herniation), and bone spurs on nerve roots. To remove compression (decompression) on nerve roots, surgeons excise cartilage and bone spurs from the front of the cervical spine under a microscope to improve blood circulation, and repair damaged function of the nerve root to improve symptoms.
What is the surgical procedure?
A transverse cut approximately 25-35 mm in length is made in the front of the neck along the skin fold. Neck muscles are retracted through the skin incision, and the front part of the cervical spine is examined to identify the lateral corner of disc space (Luschka joint). The area of the Luschka joint is excised by electric drill to expose the nerve root for decompression under the microscope (Key hole surgery). Misplaced cartilage, bone spurs, and ossified ligaments which compress the nerve root are thoroughly excised. Metallic implants are not used for stabilization. A drain tube is left in the wound and the skin is closed using DERMABOND®. A cervical brace is not applied.
The operating time is approximately one to two hours. Introduction of anesthesia and post-anesthesia arousal time take approximately one additional hour, making the total operation time two to three hours.
What is the effect of surgery?
Immediately after surgery, symptoms improve due to increased blood circulation to nerve roots. In some patients, edema or inflammation of the nerve root may occur as a result of acute decompression, and symptoms may stop improving between two days to one month after surgery. However, symptoms due to edema and inflammation subside in three to four months. Symptoms become permanent in less than 1% of patients. Improvement is much stronger in cases of nerve root damage than in spinal cord damage, and maximum symptom improvement occurs at six months post-surgery. Some patients, such as those who have long standing symptoms or severely damaged nerves, may not recover completely, leaving numbness, tingling, and weakness in the hands and arms. Long term significant weakness in the arms and hands may take one year or more to recover. In some patients, decompressed and enlarged nerve root canals may narrow or close after surgery. Approximately 1% of patients require a second operation.
What are the complications of surgery?
1. Nerve damage and dural tear
During decompression of the nerve root in a narrow canal, nerve damage could occur. When symptoms worsen due to nerve damage, usually they flare up temporarily but subside within a few weeks in most patients. These symptoms become permanent in less than 1% of patients. In the case of a dural tear, the tear is repaired immediately using a sealing method.
2. Postoperative hematoma
Blood collection may occur in the space between the trachea (wind pipe), esophagus, and cervical spine after surgery acutely obstructing the trachea. This may occur in bed after the patient is transferred to their room. The airway should be kept open immediately by intubation or tracheostomy (cutting trachea to keep the airway open), and blood collection should be removed in the operating room. This is rare and, in my personal experience, has occurred in only 0.2% of 1000 cases.
3. Difficulty swallowing or hoarseness
Edema could occur along the esophagus and the patient may complain of difficulty swallowing or hoarseness a few days after surgery. In most cases, these symptoms disappear without special care. However, some hoarseness may be a result of traction damage of the recurrent laryngeal nerve in the throat. Patients may complain of difficulty with speech or deep breathing. Typically, this takes about six months to heal without special care.
4. Eyelid drooping (Horner syndrome) or abnormal sweating (Dyshidrosis)
Eyelid drooping combined with an inset eye may appear immediately after surgery, or a few days post-surgery. Sympathetic nerves may be injured during the preparation of the surgical field due to the sympathetic nerves running along the carotid artery and cervical spine. Approximately 1% of patients may feel abnormal sweating on the same half of their body as the surgical site. Both complications typically clear up in a few months, but may persist for longer.
頚椎ヘルニア摘出の瞬間！；For those undergoing Microsurgical Anterior Cervical Foraminotomy (MacF) open subtitle | |
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| Science & Technology | Upload TimePublished on 20 Nov 2017 |
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