Tuesday, 21 January 2014

Surprise Birthday Spondylosyndesis!

An example of a post-operative multi-level cervical fusion.

Stardate: 91662.61

Overall, I have to say, today wasn't a bad birthday. I wasn't knackered upon arriving at the hospital, I'd had a decent breakfast, and I got to spend pretty much all of my day in orthopaedic theatre! I saw three cases, all of them spinal surgery, and it was great! I saw two lumbar, and a cervical spine case, and the latter was just amazing to witness. (See, I told you my posts would hopefully get more interesting!)

The patient had been suffering with a cervical spinal disc herniation between the C4 and C5 vertebrae. This is basically where a tear in the outer fibrous layer (annulus fibrosus) of the inter-vertebral disc has allowed the central jelly-like portion (nucleus pulposus) to bulge out and cause mechanical compression (pressure) upon a nerve (in this case, the spinal cord). In order to relieve this patient of their pain, surgery was undertaken, and in this case it was a spinal fusion (or spondylosyndesis). 

The type of fusion used for this particular case was ACDF (Anterior Cervical Disectomy and Fusion). This is a surgical procedure where the surgeon enters the space between the two discs through a small incision anteriorly (from the front) and to either the right or left side of the neck. The affected disc is then completely removed, and the intervertebral foramen (the channel through which the spinal cord runs) is then enlarged by a drill to allow the nerve more room. A device is placed between the two vertebrae to maintain spine alignment, and is then fixed with a 'cage' using metallic pedicle screws made from titanium. This type of surgery can take 5 hours, and although I was only in for a few of them, I saw quite a lot.

The consultant surgeon was incredibly nice and explained everything as he went along, and why he was doing it. Before we properly started he showed me some of the patient's previous MRI scans, which helped me to understand what we were actually seeing and scanning. When he'd finished doing different stages, he even encouraged me to come over and have a good look at his work, and I felt quite privileged by it, as some of the surgeons I've seen are quite offish and uninterested.

When I wasn't in theatre, I was out on mobiles, so I got to visit the ICU (Intensive Care Unit) and Oncology. I finally put into practice what I'd learnt about moving and handling (how to move yourself and patients safely), as many patients on these wards find it difficult to get into position for their x-rays. One of the elder male Oncology patients made me smile, as he was fascinated by the mobile x-ray tube, as he thought we were coming to take him back to Main X-Ray (which is about a mile away from Oncology), and he asked quite a lot of questions, and praised the technology's speed.

To finalise this post, I really had a great day in theatre, and I'm looking forward to the possibility of going tomorrow! And, I didn't faint! I knew I wouldn't!

I'm off to spend the remainder of my birthday relaxing in bed with my Spider-Man pillow, some bicuits and 'An Idiot Abroad' DVDs...

LLAP!

References
  1. Alexios Apazidis, spineuniverse.com, photograph, viewed 21 January 2014 <http://cloud2.spineuniverse.com/sites/default/files/imagecache/inline-content/images/2012/07/25/4-months-postoperative.jpg>

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