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Chapter 26 Video 1: Surgical Management of Cervical Spondylotic Myelopathy

January 23, 2017

Contributors: Chris Alan Cornett, MD

Standard positioning for posterior surgical procedures generally includes positioning in Mayfield tongs, and a slight reverse Trendelenburg position to help with venous bleeding. A midline approach is outlined and undertaken. The fascia is divided in the midline, taking care to avoid strain into the muscle, to again help avoid bleeding, and to facilitate later closing of the fascia. With the muscle reflected off of the posterior spine, good visualization of the posterior bony elements is achieved. Dissection is carried out to the lateral aspect of the lateral masses in question. Care is taken to avoid disrupting the junctional ligaments above and below the area that is to be visualized. Next, the instrumentation is performed, placing lateral mass screws in standard fashion, which are angling superiorly and laterally to avoid the vertebral artery, as well as the nerve roots. Once the screws are placed, lateral rods can be connected, as well as the set screws, and the spine is stabilized across those areas. It is generally advisable to decorticate the facet joints with a burr at this stage. Next, the spinous processes are removed to facilitate use of the burr for the laminectomy. The laminectomy is then performed, making full thickness troughs at the junction of the lamina and the lateral mass, bilaterally, so that the spinous process and lamina can be removed en bloc after division of the ligamentum flavum with a small Kerrison rongeur. Once that is removed, the margins can be cleaned up with a small kerrison. Hemostasis can be ensured, and then bone grafting can occur in the facet joints. Typically, a drain is placed, and a multilayer closure is performed.

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