We see the median nerve (outlined) which has been freed up. Note the hourglass constriction from chronic compression - truly a "pinched nerve."
Sure enough, Dr. Fink is prepping for a cervical laminectomy. And he's got a very nice exposure.
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We're looking at the back of the neck, at the spinal cord. |
The purpose of this "cervical laminectomy" is to remove the bone overlying the cord to relieve pressure. While there are many causes for imbalance and falling in the elderly - it's no mean trick standing on our spindly hind legs, takes a minimum of a year to learn) - one of the CORRECTABLE causes is myelopathy, or damage to the cord from compression in the neck due to accumulated bony changes.
Cervical Myelopathy, as it's called, results not only in imbalance but in loss of position sense in the feet. Findings may include spasticity (increased tone, clonus, upgoing toes) and the diagnosis is made by MRI.
We're in the surgical suite, watching a carotid endarterectomy. The surgeon's fingers hold the silastic bypass through which blood continues to flow to the brain even though the artery has been splayed longitudinally 1-2 inches. The EGG YOLK colored material in the wall of the vessel is a CHOLESTEROL PLAQUE. It's about to be stripped out. This procedure has been proven safe and effective for persons with 75% stenoses or greater having symptoms on the affected side. It carries a risk of death from 1-9% in different series as well as a risk of precipitating the very stroke it is intended to prevent. Like many other therapeutic options, there are choices, not always good, and prevention is preferable.
MEMORABLE QUOTATIONS FROM SURGEONS
Surgeons are naturally laconic and get a lot of wisdom into a few words:
"Never cut where you can't see."
"Never say 'oops.' Always say 'ahhh.'
This way to the Doctor's Lounge where I can assure you, medicine is never spoken, although you can get a free opinion about nearly anything else.
