Pathologies, Procedures and Room Set-Up

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Regina Benson
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1 Pathologies, Procedures and Room Set-Up

2 Degenerative diseases - arthritis, osteoperosis Most common cause for neck pain and back pain Herniated disks or bulging disk Commonly occur at L4-5, L5-S1 Spinal stenosis Narrowing of spinal canal Common in cervical & lumbar regions Tumors Most common are metastatic Cord compression causing pain and weakness

$Most common injuries are fractures, subluxation, disk herniation Cervical spine most vulnerable to injury Need early stabilization to minimize cord trauma Spinal cord$

4 Most common injuries are fractures, subluxation, disk herniation Cervical spine most vulnerable to injury Need early stabilization to minimize cord trauma Spinal cord injury Complete: lacks sensation, position sense, & voluntary motor function below level of injury Incomplete: still has some sensory, position sense & motor impulses present

$Compression fracture Degenerative changes Dislocation Herniated disk Tumor causing pressure on$

6 Removal of one or more vertebral lamina from to expose spinal canal to treat Used to treat: Compression fracture Degenerative changes Dislocation Herniated disk Tumor causing pressure on spinal cord

8 Removal of ruptured annulus fibrosus or herniated nucleus pulposus Often replaced with bone graft Herniated or ruptured disk most common injury seen by neurosurgeons Most occur in lower lumbar region

9 Stabilization of spine by locking vertebrae together Uses: Plates Screws Rods May be indicated following injury or excision of bone

11 Anterior Cervical Spine Supine with mayfield pins or horseshoe on radiolucent table or regular bed May need cervical traction Arms tucked to side Pillow under knees Anterior Lumbar/Thoracic Supine Pillow under knees Radiolucent table Rails clear for retractor (bookwalter, omni) General surgeon needed to gain access to spine

Posterior cervical Prone with head in mayfield pins or face on foam pillow Gel chest rolls, wilson, or jackson frame Arms tucked down to side Radiolucent table Posterior

12 Posterior cervical Prone with head in mayfield pins or face on foam pillow Gel chest rolls, wilson, or jackson frame Arms tucked down to side Radiolucent table Posterior lumbar/thoracic Prone on gel chest rolls, Jackson, Wilson frame, or Cloward Arms overhead not extended greater than 90 degrees Radiolucent table Make sure there are enough people to safely transfer

13 XLIF (extreme lumbar interbody fusion) Incision on patient s side Lateral decubitus position (90º) Secure body so no moving Iliac crest at break in bed

14 Bovie, suction and warmer at foot of bed C-arm available May use flat plate instead Midas Headlight May use microscope

15 Blood clot causing increase ICP and compression of brain Three types Epidural Subdural Intracerebral Burr Holes or Craniotomy or Craniectomy to decompress brain and remove/drain blood clots

16 Tumors within the brain or its membranes Metastatic tumors more common than primary Classified by histologic type glioblastoma, menegioma Symptoms Progressive neurologic deficit motor weakness Headaches and seizures Diffuse increase in ICP Depends on location

Excessive accumulation of CSF in ventricles resulting in increased ICP Due to obstruction, poor absorption, or overproduction of CSF Reasons Congenital abnormalities, aqueductal stenosis, tumor,

17 Excessive accumulation of CSF in ventricles resulting in increased ICP Due to obstruction, poor absorption, or overproduction of CSF Reasons Congenital abnormalities, aqueductal stenosis, tumor, subarachnoid hemorrhage, meningitis Common among young children and older adults Acute or Chronic Infants Enlarged head, seizures, vomitting, sleepy Adults Impaired balance, memory loss, poor coordination, headache

with plates/screws Hematoma, aneurism, tumor Craniectomy

19 Bur Holes Small hole for minimum exposure to brain Hematoma, VP shunt Craniotomy Remove bone flap and is replaced at end of case with plates/screws Hematoma, aneurism, tumor Craniectomy permanent removal of section of skull Severe head injury, tumor, infected bone

doughnut Prone Approach for occipital lobe Head in

20 Supine Approach most commonly for frontal, parietal and temporal lobes Mayfield pins or horseshoe or head on gel doughnut Prone Approach for occipital lobe Head in mayfield pins Semi fowlers Head in mayfield pins For occipital approach

Mayfield pins Bacitracin ointment for pins Surgeon will place pins and have control of head while transferring patient Do not move the patient

21 Mayfield pins Bacitracin ointment for pins Surgeon will place pins and have control of head while transferring patient Do not move the patient after pins placed and head locked in place, could break neck May turn the bed 90 or 180 degrees At least 1 arm tucked Clip hair Save hair for patient

22 Mayfield with pins or horseshoe headrest Bovie, suction and warmer at foot of bed Midas Microscope Headlight Clippers

23 Supine Arms tucked Pillow under knees Head on pillow or in mayfield May turn bed Often assisted by an ENT surgeon

24 Bovie, suction and warmer at foot of bed Microscope Stereostatic navigation Mayo prep stand to include: Local, bayonet forceps, nasal speculum, syringe and neuro patties

25 Catheter placed in ventricle through bur hole and connected to external drainage system One way valve system drains CSF away from ventricle into the peritoneum Supine May need access to abdomen Arms tucked Pillow under knees May turn bed May send CSF Confirm implant with surgeon

26 Local Bacitracin ointment Bacitracin irrigation Hemostatic agents Bone grafts Crani plates Fusion hardware

27 Electosurgery: monopolar, bipolar Bone wax Sponges Cottonoids Hemaclips

28 Thrombin Catalyzes conversion of fibrinogen to fibrin Soak cotton patties or gelfoam in thrombin and then apply topically Floseal/Surgiflo Gelatin matrix is mixed with thrombin Topical gel that clots bleeding site Gelfoam Absorbable gelatin sponge placed topically over bleeders, often soaked in thrombin

area Surgicel Oxidized regenerated cellulose pad, placed topically

29 Avitene Collagen hemostat, usually a loose fibrous form that is placed topically with bleeding surface, attracts platelets to the area Surgicel Oxidized regenerated cellulose pad, placed topically & forms clot, as absorbs it becomes gel Local Anesthetic with epinephrine

Cancellous bone chips DBX bone putty Demineralized Bone Matrix

takes up the space BMP Bone Morphogenetic Protein (synthetic) is

stimulates bone growth and the sponge gets absorbed Osteocel

30 Cancellous bone chips DBX bone putty Demineralized Bone Matrix used to fill gaps or voids in bone Absorbs as bone grows and takes up the space BMP Bone Morphogenetic Protein (synthetic) is reconstituted then absorbed into a collagen sponge The BMP stimulates bone growth and the sponge gets absorbed Osteocel Contains stem cells so acts like autographs because biologically active Kept in freezer

Neuro/Spine. April 27, 2012

Neuro/Spine. April 27, 2012 Neuro/Spine April 27, 2012 Anatomy Review Skull Bones Protection for the brain Sutures bony seams 8 Cranial cavity bones Frontal, occipital, ethmoid, sphenoid, temporal, parietal Meninges Fibrous membranes