Anterior Cervical Discectomy and Fusion
Initial posting by: Bernard Bendok, MD
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Anterior Cervical Discectomy is a treatment for spondylotic myelopathy or radiculopathy. Patients are placed under general anesthesia and positioned supine with the neck in slight extension. Useful surface landmarks include the cricothyroid membrane (C6), thyroid cartilage (C3-4), and angle of the jaw (C2-3), although C-arm fluoroscopy may also be used to plan the incision. Right-handed surgeons prefer to operate from the right but should be mindful of anatomical variations in the course of the recurrent laryngeal nerve. One or two level discectomies only require an incision along a skin fold, whereas the edge of the SCM should be used for larger operations. Once the platysma has been divided, the SCM should be identified and retracted laterally. Other important structures to identify and properly retract include the laryngeal strap muscles (retract medially), carotid sheath (laterally), trachea and esophagus (medially). The longus coli muscles and ALL lie just anterior to the spine. The longus coli muscles are retracted and the microscope is brought in for the actual discectomy and fusion. Complete removal of disk material is desired to enhance fusion and ensure adequate decompression of neural structures. Bony narrowing from osteophytes should be drilled down as well. The PLL is removed so any subligamentous disk material can be identified. Graft material is inserted between drilled down end plates and may consist of bone from the iliac crest of fibula (autograft or cadaver), osteophyte material obtained during discectomy, and/or Bone Morphogenic Protein (BMP). Multi-level fusion may benefit from anterior cervical plating. Upon closing the carotid artery and esophagus must be inspected for minute tears. A hard collar should be worn for 6 weeks in patients undergoing multi-level fusions, trauma, or corpectomy.
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