Due to the important functions of the sacral nerve root, including urination and defecation, sexual function, and lower limb motor sensation, the sacral nerve root should not be damaged during surgery. The following is the experience of Dr.Zheng’s team.
1. The surgery must be performed under a clear microscopic field of view. If the blood and flesh are blurry, it may be difficult to see the nerves clearly and accidentally injure them.
2. Performing a total laminectomy of the sacral canal is not advisable due to its irregular shape. Such procedures may result in more bone wound and inadvertently harm nerves. Furthermore, the bone wound created during a total laminectomy increases the likelihood of bleeding, which can obscure the surgical field and compromise visibility.
3. Try to control the amount of bleeding inside the sacral canal as much as possible. If there is a large amount of bleeding, the process of stopping bleeding can also easily damage nerves.
4. For cyst leaks with nerve roots passing through, the cyst neck cannot be ligated, and the leak can be sealed by microsurgical suturing. It is necessary to tightly seal the leak, prevent dripping, and ensure that the nerve roots are not damaged.
5. Intraoperative neurophysiological monitoring: Needle electrodes are placed around the anus, genitals, thighs, and calves before surgery, and concentric circular electrodes are connected during surgery. Electroencephalography, EMG, SEP, BCR, and other parameters are recorded throughout the surgery to ensure that the nerves are not damaged.
EMG: Resting state
