微創腰椎內固定手術 (經神經孔腰椎融合手術)

需要永久內固定腰椎關節的情況：

• 嚴重脊椎骨移位
• 嚴重雙側椎間盤脫位
• 復發性椎間盤脫位

經考慮不適合其他非固定或動態固定的方法，應該考慮使用微創腰椎內固定手術。

手術後治療

• 手術平均需要3小時。
• 手術後下一天可如常走動。
• 平均住院約三天。
• 輕微傷口痛會維持兩星期至兩個月。期間可正常活動。

過往接受類似手術的病人中超過九成病人的坐骨神經痛和會明顯改善，
而活動能力能夠達到同年齡人仕的程度。




手術的風險和併發症

• 常見短期不適: 傷口肌肉痛、傷口腫脹、輕微的腳痹痛。
• 少於百份之三出現但比較嚴重的併發症: 傷口流血、細菌感染、神經線持續發炎、腦脊液滲漏、椎骨不能融合。這種情況下，一般祇需要休息和藥物治療，在某些情況下可能要進行手術治療。
• 腰椎固定後，腰部受力點有可能會轉移至骶髂骨關節造成臀部痛。通常這種痛經過適應期便會消失。如果持續，可考慮關節注射或射頻治療。
• 未有出現過，但無法完全排除的嚴重潛在風險: 長期背痛及植入儀器移位，雙腳無力，大小便失禁。

參考資料 : http://www.brain-spine.com.hk/
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向香港神經外科醫生查詢，而不應單倚賴以上提供的資料。

椎間盤手術 - 管道式微創椎間盤切除神經線減壓手術

腰椎椎管/需要用管道式微創椎間盤切除神經線減壓手術的病症

• 單側坐骨神經痛，痛楚於走路時或坐久時增加。
• 磁力共振素描顯示: 
• 腰椎神經線受脫位椎間盤壓迫。 
• 神經線沒有在神經孔外側受壓。
• 相對「透皮水刀手術」和「全內視鏡椎間盤手術」，「管道式微創椎間盤手術」適合較年長有骨刺之患者和脊椎盤突出時間已很久的病人。

椎間盤手術的一般步驟

• 手術會在全身麻醉下進行。 手術時間約1小時內。
• 麻醉後放置電位神經線監察儀器。
• 利用X光導航經正中偏左/右側腰部傷口放置約16mm直徑管道儀器。整個手術將會在這管道內進行。
• 利用顯微鏡及微創儀器，移除壓著神經線的組織，可能包括小量椎板、小量小面關節、黃韌帶和椎間盤脫位的部份。
• 只切除椎間盤脫位的部份，保留腰椎承托力。
• 最後縫合傷口

椎間盤手術後治療

• 坐骨神經痛及背痛會消除或減至輕微的程度。
• 手術後24小時可如常走動。
• 平均住院約兩天。
• 輕微傷口痛會維持數天至數星期。
• 首雙星期用腰封減少傷口痛。
• 由於腰椎活動能力保留，其鄰近關節退化較融合手術低。

椎間盤手術的風險和併發症

• 常見短期的併發症: 傷口痛，傷口腫脹，腳部輕微的痹痛或刺痛。
• 很少出現的併發症: 傷口流血、細菌感染、神經線持續發炎、腦脊液滲漏。如果出現這些情況一般只需要藥物及休養，在某些特殊情況下可能要進行手術治療。
• 未有出現過的潛在嚴重併發症: 腳步無力，大小便失控
• 一般麻醉引發潛在的疾病、如心臟病或過敏反應。
• 手術後有很少的機會，椎間盤脫位復發。復發機會視乎原有椎間盤脫位的嚴重程度。

參考資料 : www.brain-spine.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向香港神經外科醫生查詢，而不應單倚賴以上提供的資料。

本腦炎 / 流行性乙型腦炎 Japanese Encephalitis / Epidemic Encephalitis B

日本腦炎病毒的宿主是豬隻或野生雀鳥，而主要病媒是三帶喙庫蚊，庫蚊在叮咬過帶有日本腦炎病毒的豬隻或野鳥後，身上就帶有該些病毒；庫蚊再叮咬人類，人類就可能被感染日本腦炎。

病徵:
日本腦炎發病的潛服期為四至十四天。病情輕微者出現無力、發燒及頭痛症狀。病情嚴重者則病發得快，並出現頭痛、高燒、頸部僵硬、神志不清、昏迷、震顫、抽搐（特別是幼童）及癱瘓等症狀。患者有可能出現腦膜炎等嚴重病癥，

死亡率可高達三成。

成因:
日本腦炎是經由庫蚊傳播，並不會人傳人，因為人類即使染病，體內的日本腦炎病毒也不會像豬隻或野鳥般多，故蚊子叮咬了患者後，再叮人的傳播風險不大。

預防方法 :
預防日本腦炎，應採取防蚊措施，避免給蚊子叮咬。準備前往此病流行地區如越南、柬埔寨、緬甸、印度、尼泊爾及馬來西亞的人士，更應加倍注意。應避免前往郊外，或穿著長袖衣服及準備蚊怕水。

治療方法:
日本腦炎並無特定的治療方法。醫生一般對患者施以支援性治療。

此病的死亡率為百分之五至三十五，康復者可能有神經系統的後遺症。

是否有季節性?  否

藍明權  神經外科醫生

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向神經外科醫生查詢，而不應單倚賴以上提供的資料。

Degenerative Disc Disease (DDD) (4)

PLIF

The PLIF procedure takes a posterior (from the back) approach to the lumbar spine through an incision in the patient’s back. The surgeon must detach and move muscles attached to the vertebral, and in some cases a portion of vertebral bone called the lamina, may be removed for better visualization and access to the disc space.

-Surgical times ranges from 3 to 8 hours

-Hospital stay ranges from 3 to 5 days

-Typically a 6-inch incision

-Dissection of muscle and soft-tissue of the spine can cause post-operative pain and slow healing process

-Risks reported in literature of vascular injury, nerve injury, incontinence, impotence, muscle and tissue scarring

TLIF

Like the PLIF procedure, TLIF begins with a posterior (from the back) incision, however the surgical angle approaches the vertebra more laterally, or diagonally toward the patient’s side. The altered approach to the spine, compared to PLIF, limits some of the operative trauma to supporting muscle and soft tissue.

To access the disc space, the surgeon may remove a portion of the lamina (a bone covering the spinal nerves) and all of the facet joint, which is a major stabilizer of the spine. The access route, though less invasive than the PLIF procedure, still involves disruption of muscle, soft tissue and nerves and it may pose a risk of post-operative pain and complications.

-Surgical times range 2 to 4 hours

-Hospital stay ranges from 3 to 5 days

-Typically a 4-inch incision

-Risks reported in literature of vascular injury, nerve injury, incontinence, impotence, muscle and tissue scarring

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Degenerative Disc Disease (DDD) (3)

Treatments

There are various methods of treating low-back pain including both non-surgical, and surgical techniques. Your doctor will work closely with you to isolate the source of your low-back pain and recommend the course of treatment that is most appropriate for you.

In most cases, a non-surgical treatment will be recommended. Treatments can range from exercise and behavior modification, to medications that reduce pain or swelling, or epidural injections. While some patients may improve with non-surgical treatments, others may try several treatments without success. In such cases, doctors may recommend a surgical treatment.

Fusion techniques

There are several surgical techniques available for spine fusion. Traditional techniques approach the spine directly through open incisions, while newer, minimally invasive techniques approach the spine through small incisions. If you require spine fusion, the fusion techniques selected may depend on the treatment required for your particular case, individual anatomy, or on the preferences of your surgeon.

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Degenerative Disc Disease (DDD) (2)

Spondylolisthesis

Spondylolisthesis occurs when one vertebra slips forward in relation to an adjacent vertebra. The symptoms that accompany spondylolisthesis include pain in the low back, thighs and/or legs, muscle spasms, weakness, and/or tight hamstring muscles.

-Degree of slippage classified in grades, Grade I being the least amount, Grade IV the most

-Many people affected experience no pain or symptoms

-May result from improper lifting of heavy items, weightlifting, or high impact sports, such as football or gymnastics

Common symptoms

-Low back pain

-Lordosis (swayback)

-Pain and/or weakness in legs

-Tightness in the hamstrings (muscles at back of thigh)

-Symptoms grow worse with exercise

Spinal stenosis

Spinal stenosis is the narrowing of the canal that surrounds the spinal cord. The narrowing can be caused by the enlargement of joints, arthritis, bone spurs or the calcification of ligaments in the spine. As the canal narrows, pressure may be placed on nerves causing pain and/or numbness felt in the back and legs.

-A degenerative condition that is most common in older adults

-Years of wear-and-tear contribute to the condition

-It is possible to be born with spinal stenosis

Common symptoms

-Low back pain

-Weakness, tingling, numbness or pain in legs

-Standing or walking brings on symptoms

-Rest may reduce symptoms

-Leaning forward often relieves symptoms

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Degenerative Disc Disease (DDD)

Degenerative disc disease is not truly a disease. It’s a term used to describe the gradual deterioration of intervertebral discs that may occur naturally with the aging process or as result of injury.
-loss of hydration in the disc can shrink the disc and compromise its ability to act as a shock absorber between each vertebra

-loss of disc height can place pressure on the nerve roots causing pain in the buttocks and legs

-ruptured discs can bulge and put pressure on nerves causing leg and back pain




Common symptoms

-Low back pain
-Pain in legs and/or buttocks
-Pain may increase while sitting or standing for extended time
-Pain may decrease while walking, or laying down

Conditions contributing to low back pain

Painful conditions of the spine may be difficult to understand because often the pain is felt elsewhere, such as in your legs or buttocks. This pain is caused by pressure placed upon the nerves that pass through your spine and extend through the rest of your body.


We’ve seen how the healthy spine works to protect its own structure, including the spinal cord and the nerves that pass through it. We’ll now focus on some conditions that can compromise the normal structure of the spine resulting in nerve compression and pain:

-Degenerative Disc Disease
-Spondylolisthesis
-Stenosis








It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Why do I need surgery?(2)

Preparing for surgery

You may be told to see your general practitioner before surgery to check your overall health. Tell your doctor what medications you are taking, and ask if you should stop taking any medications before surgery. To make your recovery easier, prepare your home for life after surgery. Place important things within easy reach. Remove safety hazards that might cause you to lose your balance. Arrange for someone to help you at home and around the house after surgery. You will most likely be told not to eat or drink the night before the surgery. Be sure you read and understand this entire booklet. Your surgeon is required to let you know of the potential risks, as well as benefits, of this surgery.

After surgery

Ask your surgeon about your specific recovery plan following surgery. It is important to follow your doctor’s instructions carefully to recover from surgery as quickly as possible and increase your chances of a successful outcome.

After surgery your surgeon may refer you to physical therapist who will teach you exercises to improve your strength and increase your mobility. The goal of physical therapy is to help you become active as soon as possible, using safe body movements that protect your neck.

Recovering from pain and surgery is an ongoing process. How fast you recover depends on your commitment to working closely with your physical therapist, and moving and exercising correctly, as recommended by your surgeon.

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Why do I need surgery?(1)

As discs lose their water content because of disease or age, they lose their height and bring the vertebrae closer together. The consequence is a weakening of the shock absorption properties of the disc and a narrowing of the openings for the nerves in the sides of the spine. Additionally, a loss of disc height may cause the formation of bone spurs, which can push against your spinal cord and/or nerves.

When a disc ruptures in the cervical spine, it puts pressure on one or more nerve roots (called nerve root compression) or on the spinal cord, causing pain and other symptoms in the neck and arms. Living with this pain or weakness and tingling in the arms can be disabling.

Disc degeneration

With the advice of your doctor, you may have tried other treatments for some time now which did not relieve your pain or dysfunction. Or perhaps your doctor has determined that irreparable damage would result without surgery. Your doctor has recommended that you consider the PRESTIGE® LP Cervical Disc Prosthesis, which provides for motion following surgery, instead of the more common fusion procedure.

What is involved in a PRESTIGE® LP Cervical Disc System procedure?

This surgery involves the use of a new medical device, which is designed to replace the disc which sits between the vertebrae in your neck. Your disc, which is damaged or diseased, is surgically removed through an incision made in the front of the neck.

In its place, your surgeon will prepare a space and insert a PRESTIGE® LP Cervical Disc Prosthesis. The device utilizes a ball and socket design which is designed to allow for motion to be preserved.

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.