Neuroscience Clerkship

 

 

SURGERY OF THE SPINAL CORD, NERVE ROOTS AND PERIPHERAL NERVES

Above: diagram of a lumbar laminectomy.

 

SPINAL CORD AND NERVE ROOTS

Primary indication: an abnormal neurological examination that points to an unexplained problem in the spinal cord or nerve roots.

Secondary indication: instability of the spine

Work-up includes:

MRI in all cases

Neurophysiological studies (SSEP, EMG) in selected cases

When hemorrhage or infection are in the differential diagnosis, an LP is done

When ischemia is in the differential diagnosis, spinal cord angiography is done

When spinal instability is present, a CT (with or without a myelogram) is done

Surgery

Indications include:

Instability of the spine

Loss of neurological function (esp. loss of bladder function)

Presence of a tumor that requires a tissue diagnosis

Techniques include:

Laminectomy

Laminotomy with discectomy

Corpectomy with fusion (anterior cervical or transthoracic approach)

Tumor resection, and instrumentation

Postoperative care includes physical and/or occupational therapy


Above: exposure of the median nerve for carpal tunnel release.

PERIPHERAL NERVE

Primary indication: an abnormal neurological examination that points to an unexplained problem in a major mixed nerve

Secondary indication: acute trauma to an extremity

Work-up consists of:

EMG in all cases

MRI in selected cases

When tumor is in the differential diagnosis, MRI is done

When ischemia is in the differential diagnosis, angiography (and/or venography) is done

Surgery

Indications include:

Visibly divided nerve within an open wound

Loss of neurological function that has been localized by EMG

Presence of a tumor that requires a tissue diagnosis

Techniques include:

Release of entrapment

Transposition

Debridement

Perineurial suture (with or without fresh autogenous nerve graft)

Epineurial suture

Limb shortening

Tendon transfer

Tumor resection

Postoperative care includes physical and/or occupational therapy