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Hello, I'm doctor Ali Biden, a neurosurgeon specializing in
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the treatment of spinal disorders at John Hopkins University.
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I wanted to share with you a video presentation regarding a
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common condition that we encounter quite frequently - cervical disc herniation.
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Patients usually present with neck pain,
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arm pain, difficulty with fine mtor movements
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of the hand, weakness in the hand, gait and stability and urinary problems.
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This particular patient was found to have a
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large cervical discrimination which was compressing her spinal
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cord that we treated via surgical removal using
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a small incision in the neck and microscopic guidance.
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Here is the intra operative video taken during surgery.
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The patient in this illustration is lying, eh, on their back
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and a small insertion has been performed in the neck.
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The vertebral bodies are exposed and so is the disk.
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You can see us here drilling through the disk.
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The drilling continues until we encounter the bones or the
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end plates on the other side of the disc, which is where the spinal cord would be.
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And here's another illustration of where the
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vertebral bodies are and where the disc is.
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This procedure is done under microscopic guidance.
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And here you can see that we are removing disc pieces
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that have herniated through the annulus and are compressing the spinal cord.
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And these are 2 small pieces, 2 medium sized pieces that we have removed
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from there.
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The decompression continues.
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As you can see with the usage of multiple instruments,
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and there we will keep on going until we see the spinal
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chord which is the best measure of decompression of the spinal chord.
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As we are trying to remove the
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last pieces of disc we
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encounter a piece that has
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herniated
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backwards and is causing compression of the spinal cord.
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And with the use of a nerve hook,
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we are going to tease out that last piece that has herniated.
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And the nerve hook has not been brought to the
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field yet, as we are still trying to remove the
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last pieces of the annulus prior to going
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for the large piece fragment that has herniated.
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So this is an illustration of the large herniated
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disc fragment which we can feel with our [UNKNOWN]
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and here we are gonna go with the nerve hook and see if we can tease it out.
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We will place the nerve hook right on the spinal cord and
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see if we can remove that piece and here comes that piece.
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It's a large piece of disc that was straight on
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the spinal cord causing significant compression of the spinal cord.
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Here's another couple of small pieces as well that are also coming out.
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That's not uncommon for discs to come in fragments as you can see here.
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The large piece has been removed and the small
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pieces as well which were compressive have been removed.
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Another piece
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is discovered
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and has been
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teased off of the spinal cord.
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And here goes another big one.
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At this point you can see that the spinal cord has been decompressed.
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You can see the spinal cord and its small vessel on top of it.
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And it is completely decompressed and all the disk fragments have been removed.
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And that's another illustration of the spinal
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cord which is that white, glossy structure
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and at the end we would place a bone graft followed by a titanium plate.