What Is Post Laminectomy Syndrome?

Spinal tuberculosis complicated with paraplegia, and had undergone decompression and decompression of the ribs and transverse process resection. No recovery or unsatisfactory recovery was found. There was still obstruction in the lumbar puncture queens test. CT or MRI showed that there were still lesions in the spinal canal. After the spine stability was restored, the second stage of laminectomy was performed to clear the decompression. Vertebral arch tuberculosis complicated with paraplegia. Cervical spinal tuberculosis complicated with paraplegia, and the paralysis was not improved by removing the anterior lesions. However, it is almost impossible to remove the lesions in front of the spinal cord, especially the upper cervical spine, by posterior approach, and it can only be used for decompression.

Laminectomy lesion decompression

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Spinal tuberculosis complicated with paraplegia and menstruation

Spinal tuberculosis patients with paraplegia are generally not in good condition and cannot tolerate thorough surgery. Long-term preparation will affect the recovery of paraplegia. Posterior laminectomy can be performed first to achieve the purpose of partial decompression.

A longitudinal incision is made along the posterior midline. If the posterior process of the spine is obvious, in order to avoid postoperative scar pain, a paraspinous incision can be made. The incision is centered on the lesion and the length should be determined according to the extent of the lesion.

To remove the same bone and joint tuberculosis, you need to pay attention to:

1. The vertebral tuberculosis is severely damaged, and those with posterior deformity can be positioned according to the posterior process. The posterior process is not obvious, and those who lack body surface positioning markers can be located by using the blue injection positioning method before surgery.

2. If it is cervical tuberculosis and the vertebral body is severely damaged, it should be used to stabilize the traction of the skull and correct the posterior process.

3. For patients with a wide range of spinal cord compression, postoperative myelography or CTM should be performed to determine the compression range, and the surgical design should be performed accordingly. If the range is more than 5 spines, the lesions should be removed in stages to avoid damage to the stability of the spine. In the first phase, the upper lesions should be removed first.

The prone position has a certain effect on the gas exchange of the patient. It is advisable to use intratracheal anesthesia or local anesthesia. Patients with spinal tuberculosis should not use epidural anesthesia or spinal anesthesia to prevent the spread of tuberculosis.

1. Posture position. Pay attention to make the patient as comfortable as possible, especially when selecting local anesthesia. In order not to affect breathing, use a soft pillow or stent to raise the shoulder joint and pelvis. If this operation is performed on the cervical spine, the head support should be lowered to flex the cervical spine and reduce the cervical lordosis to facilitate exposure.

2. Make a longitudinal incision along the posterior midline. If the posterior process of the spine is obvious, in order to avoid postoperative scar pain, a paraspinous incision can be made. The incision is centered on the lesion and the length should be determined according to the extent of the lesion.

3. Exposing and removing the lamina After exposing the lamina, the interspinous ligament is removed or the spinous process is cut directly from the root of the spinous process to remove the spinous process to be removed in order. The ligamentum flavum was excised in the laminar space at the root of the lowest spinous process, and the dura mater was separated under the lamina with a dura stripper. Then, the lamina was bitten with a rongeur to gradually expand the exposure. Cut both sides of the lamina to the inside of the articular process, and go beyond the lesion area to the normal dura mater. Bone wax is used to stop bleeding on the lamina infiltration surface to protect the surgical field.

4. Clear the lesions Before removing the lesions, the dura mater should be observed to determine the level of obstruction. If there is tuberculous granulation or fibrous scar tissue surrounding the dura mater, the upper and lower bounds should be exposed first. Carefully separate the tuberculous granulation from the dura mater from a normal epidural epidural stripper and then lift it with forceps to cut it out. . Use your fingers to gently touch the dura mater. If there is a feeling of protrusion on the front side, you can use the nerve root pull hook on the neck and lumbar spinal cord to gently pull the dura mater and the spinal cord through the upper and lower nerve roots with a small curette. Remove the lateral and anterior lesions, and then remove the contralateral one after removing one side; for example, in the thoracic spine, 1-2 nerve roots can be ligated and severed (to prevent the lesions from spreading into the subarachnoid space). Pull the spinal cord to reveal and clear the anterior lesion.

After the lesion has been cleared, check whether the dural pulsation has fully recovered. If the pulsation does not recover, use the catheter to explore the upper and lower spinal canal without obstruction, and the dura mater or pathological changes in the dura mater; or after laminectomy, there is no lesion outside the dura mater, but The spinal pulsation is blocked and cannot be transmitted. At this time, the possibility of spinal tumors or intradural tuberculosis should be considered; if the spinal cord is enlarged and the finger is lightly touched to the induration, the above possibility is greater, and the hard spine should be cut. Membrane exploration processing. For incision and exploration, see spinal canal-spinal cord exploration.

5. After suture removal of the lesion and recovery of dura mater, the wound was flushed with normal saline to fully stop bleeding, and 1 g of streptomycin powder was built into the lesion. If the spine is unstable, it can be fixed with a Harrington rod or other internal fixator, and then the muscles, fascia and skin are sutured layer by layer. No drainage.

1. Prevention of spinal dura mater Dura mater rupture will spread epidural lesions into the dura mater and should be prevented. Before removing the lamina, the dura mater must be fully separated with the dura mater under the lamina, and then extended into the small bite forceps to bite the lamina and remove the ligamentum flavum. When the laminae are attached to the dura mater, they must be carefully separated. If the adhesions are tight and there are many scars that cannot be separated, the laminae can be removed from the lower normal part, which is easy to identify and separate, and not easy to damage. When the bone fragments cannot be taken out with the rongeur due to adhesion, do not apply force to tear, so as not to tear the dura mater. The bite forceps should be loosened, the bone fragments should be lifted with tweezers to see the tissue, cut off the adhesion, and then remove the bone fragments.

When removing the lesion, the lesion should be separated from the dura mater. For those with tight adhesion, they can begin to separate from the normal epidural. When the adhesion cannot be separated, it can be partially excised. Avoid violent separation to avoid tearing. In case of tearing, it should be covered with a cotton pad, and the outflowing cerebrospinal fluid should be sucked up and then repaired.

2. Avoid Spinal Cord Injury Spinal cord injury is a rare and serious accident, mostly caused by rough operation. The bone-clamping forceps should be fully loosened when inserted under the laminae. The other hand should control the forceps end and bite off in small pieces. Be sure to bite the bones to avoid the sudden loss of the forceps and contusion of the spinal cord. Pull the spinal cord lightly, avoid violence.

3. When the laminae are exposed, multiple pieces of gauze must be used to block the hemostasis. When the gauze is soaked in blood and stuck to the muscles, it is easy to be mistaken for muscles and left in the wound. Special attention should be paid to prevention. Each gauze must have a gauze head exposed outside the cut and must be counted.

1. Strengthen paraplegic care to prevent pneumonia, urinary tract infections, and bedsores.

2. For those with a wide range of laminectomy after surgery, avoid flexion and twist when turning over to prevent spinal dislocation.

3. If the dura mater is damaged during surgery, drugs such as sodium glutamate should be administered intravenously to prevent the disease from spreading.

With oral tuberculosis lesion removal.

With oral tuberculosis lesion removal.