Gulsen Salih
Department of Neurosurgery, Medical Faculty, Baskent University, Ankara, Turkey.
J Neurosci Rural Pract. 2014 Nov;5(Suppl 1):S83-5. doi: 10.4103/0976-3147.145218.
Enlarged thyroid gland (goiter) may hinder to reach anterior part of the vertebrae or may impose more retraction than usual. The patient had left arm pain, and his left biceps muscle strength was 3/5 and triceps muscle strength was 4/5. Physical examination of his neck showed no abnormality. We performed anterior cervical discectomy, but we did not reach to the anterior part of the vertebrae due to enlarged thyroid gland even making moderately forceful medial retraction. It is therefore, we performed thyroidectomy previously, and later we performed anterior cervical discectomy at the level of cervical 5-6 and cervical 6-7. It will be wise to excise the goiter and later continue to cervical discectomy rather than using forceful retraction in cases with no preoperative detection as in our case to prevent damage of the recurrent laryngeal nerve and hoarseness due to pressure effect of the medial retraction during the anterior cervical approach.
甲状腺肿大（甲状腺肿）可能妨碍触及椎体前部，或者可能需要比平常更多的牵拉。患者有左臂疼痛，其左侧肱二头肌肌力为3/5，肱三头肌肌力为4/5。对其颈部进行体格检查未发现异常。我们进行了颈椎前路椎间盘切除术，但由于甲状腺肿大，即使进行适度有力的向内侧牵拉，仍无法触及椎体前部。因此，我们先进行了甲状腺切除术，之后在颈5-6和颈6-7水平进行了颈椎前路椎间盘切除术。对于像我们这种术前未检测到甲状腺肿大的病例，明智的做法是先切除甲状腺肿，然后再继续进行颈椎间盘切除术，而不是像我们这样强行牵拉，以防止在颈椎前路手术中因向内侧牵拉的压力效应导致喉返神经损伤和声音嘶哑。
