By Robert G. Watkins III, Robert G. Watkins IV
In the years sin~e ebook of the Hrst version of SurgicaL ways to the backbone, a revolution has taken position in spinal surgical procedure, Spinal expertise has exploded, thereby in creasing the necessity for a number of entry websites to the backbone. The e-book was once initially written as the spinal health professional occasionally lacked the power to strategy the backbone with the suitable method. hence, spinal difficulties have been usually dealt with with a posterior process while the remedy theories and biomechanical issues of the backbone dictated an anterior strategy. Then John O'Brien and different anterior surgeons started to emphasize the necessity to excellent the technique in order that the best operation was once supplied for every imli vidual sufferer. via our paintings over the past twenty years, with surgeons comparable to Salvador Brau, a spinal entry healthcare professional, surgeons are actually devoted to delivering a secure, pain-free method of the backbone. it will eventually be to the patient's nice virtue. Advances in intradiscal dcvices, prostheses, and fusion techniqucs have mandated a secure and effec tive anterior method of the backbone. An operation to alleviate spinal discomfort can't exist if the process produces extra ache than the unique challenge. This moment variation comprises chapters on very complex operations, equivalent to the ap proaches to the sacrum and pelvis, the complete vertebrectomy, trans clavicular cervicothoraeic strategy, and anterior method of the clivus of CI-C2. it's those significant operations that positioned the sufferer' s lif~~ in jeopardy and require services within the approach.
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A preoperative orthopantomogram will accurately identifY the dental roots. Titanium miniplates, held in position with titanium screws (Leibinger, Muhlheim-Stetten, Germany) are screwed into the maxillary buttress and the alveolar margin such that they avoid the dental apices. Two additional plates may be inserted posteriorly at the third molar buttress of bone. The plates are then removed and a saw cut made along the line described. The upper alveolar margin and palate are downfractured into the mouth, the vomer divided, and the inferior turbinates incised and reflected laterally or, if particularly large, removed.
Remember: 1. 2. 3. 4. 5. 6. 7. 8. Avoid thc superficial cutaneous nerves on the sternocleidomastoid muscle. IdentifY the medial edge of sternocleidomastoid. Know where the carotid pulse is at all times. Isolate the hypoglossal nerve before ligating any arteries. Identify the superior laryngeal nerve and its internal and external branches. Dissect carefully to retract the esophagus from the spine. Incise the prevertebral fascia in the midline. Dissect in a lateral cephalad direction to remove longus coli in this area.
EM uon '(edlal Border or Icmoclcldoma I Id 1usclc FIGURE 68. After the skin incision, dissect through subcutaneous tissue to platysma muscle, which in this specimen is very thin. Open the platysma muscle carefully in line with its fibers. Beware of damage to veins and the sternocleidomastoid muscle (SCM). Insert spring retractors. 50 SURGICAL APPROACHES TO THE SPINE FIGURE 6C. The key to the dissection at this point is to identify the medial border of the sternocleidomastoid muscle. With lateral retraction of the sternocleidomastoid, the interval between this muscle and the medial strap muscles is delineated.