Surgical purpose:
Implementation of neurosurgical technique to recover injured spinal nerves and to improve the nerve function.
 
Examinations for surgery:
  1. Preoperative examinations include spinal series X-Ray, CT, MRI, nerves conduction study and electromyography, urodynamic study, Somatosensory Evoked Potential (SSEP), Motor Evoked Potential (MEP) at outpatient department.
  2. The doctor will explain the process, purpose, and the complications of the operation to the patient and family during pre-surgery meeting. The patient will fill up operation consent form, anesthesia consent form, blood transfusion consent form and payment consent form afterwards.
  3. After admitted, electrocardiography, chest X-ray, and blood tests will be performed.
  4. A neck collar will be prepared by surgeon’s order, for daily activities after surgery.
  5. The doctor will mark the site of surgery. Please keep the surgical mark.
  6. An enema will be performed the night before operation to cleanse the colon and reduce the inconvenience of being unable to get out of bed after operation.
  7. To avoid adverse effects of anesthesia, no food or water is allowed after midnight before surgery.
  8. In the morning of surgery, the patient will change into the surgical gown. Also remove dentures, glasses (contact lenses included), nail polish, watch and jewelry.
 
Postoperative care:
  1. After operation, the patient will have wound drainage, such as intravenous lines, and urinary catheters. While the patient reaches a stable condition, all of these drainages will be removed. Do not remove any drainages by yourself. 
  2. After returning to the ward, if the patient does not feel nausea or vomiting, and has a normal bowel movement, the patient can follow the oral intake instructions. The patient could drink water first, if there is no discomfort, the patient can intake regular diet.
  3. For surgical wound pain, the doctor will use painkillers to relieve pain.
  4. To prevent pressure injury, the nurses will assist the patient to change body position with turning sheet every two hours. (Log Rolling Technique)
  5. The patient needs to wear collar to protect neck after surgery. The length of collar wearing will vary, and will depend on the neck condition. Usually, the neck collar will be worn for several months.
  6. Start bedside joints range of motion exercise on the day after surgery.
  7. Follow physician's instruction to get out of bed. The nurse will show you how to wear the collar and assist you to get out of bed.
 
Home care and rehabilitation:
  1. Keep the wound clean and dry. If redness, swelling, heat, or severe pain occur, please come back to hospital clinic for medical attention immediately.
  2. Stitches will be removed around 7 to 10 days after surgery. If the patient has diabetes mellitus, it may be longer depending on the healing condition. After stiches removed, steri-strips could be put on to avoid scar formation.
  3. Bowel training: A high fiber diet, medications, abdominal massage, anus stimulation and enema can maintain and promote defecation.
  4. Bladder training: Based on bladder volume and residual urine volume, adjust the duration for intermittent catheterization. If the residual urine is less than 100ml, or the ratio of self-urination and residual urine lower than 3:1, continuously for two weeks, stop catheterization could be considered. Final consideration would be based on the results of urodynamic test. Physicians would order renal function and urodynamic tests according to patient’s condition.
  5. Training for motor and sensory function:
    1. 0-2 weeks: Massage four extremities and perform passive range of motion exercise for joints.
    2. 2-4 weeks: Increases passive range of motion activity, with active joint activities, at the same time arrange the bladder training and bowel training.
    3. 4-8 weeks: Continue active movement of joints. Strengthen four limbs and keep range of motion accordingly. At this stage, patients can arrange rehabilitation programs at the clinic.
    4. 2-12 months: The patient continues to be rehabilitated in a rehabilitation hospital near his home and visits the neuro-regeneration clinic every month. The doctor will arrange neurology physical examination, electrophysiological examinations, renal function, and image study according to your condition.
 
Reference
  1. Shah, M., Peterson, C., Yilmaz, E., Halalmeh, D. R., & Moisi, M. (2020). Current advancements in the management of spinal cord injury: A comprehensive review of literature. Surgical Neurology International, 11, 2. doi: 10.25259/SNI_568_2019
  2. Sharma, A., Sane, H., Gokulchandran, N., Badhe, P,, Paranjape, A., Kulkarni, P.,& Nair, V. (2019). Neuroregenerative-rehabilitative therapy for spinal cord injury. in spinal cord injury therapy. IntechOpen. doi: 10.5772/intechopen.88808
  3. Yang, X. X., Huang, Z. Q., Li, Z. H., Ren, D. F., & Tang, J. G. (2017). Risk factors and the surgery affection of respiratory complication and its mortality after acute traumatic cervical spinal cord injury. Medicine, 96(36), e7887. doi:10.1097/MD.0000000000007887
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