Indications for Procedure
- Weakness: Motor weakness is present in the lower extremities.
- Gait deterioration: Worsening gait abnormalities and difficulty walking occur.
- Loss sensation: There is impairment of lower extremity sensation or saddle anesthesia.
- Pain: Intractable back pain is present.
- Deteriorating urological function: Worsening impairment of bladder function is apparent.
Preoperative Orders
- Routine
Anesthetic Considerations
- Positioning: Particular attention should be paid to the pressure points such as the chin and eyes during surgical positioning.
- Blood pressure: Hypotension must be prevented.
Devices to be Implanted
- Dural sealant: Fibrin glue or blue glue should be available for sealant of the dural closure.
Ancillary/Specialized Equipment
- Intraoperative monitoring: Motor and sensory evoked potentials as well as free-running EMG can used.
- Microscope: The surgical microscope may be used. However, surgical loupe magnification is often sufficient.
- Localizing plain radiographs: MRI or CT may be useful, particularly if a split cord is present.
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