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anterior_cervical_discectomy_and_fusion_technique

Anterior cervical discectomy and fusion technique

(in lay terms for the patient – not all-inclusive):

a) procedure: surgery through the front of the neck to remove the degenerated disc and bone spurs, and to place a graft where the disc was, and possibly place a metal plate on the front of the spine. Some surgeons take bone from the hip to replace the removed disc.

b) alternatives: nonsurgical management, surgery from the back of the neck, artificial disc (in some cases).

c) complications: swallowing difficulties are common but usually resolve, hoarseness of the voice (<4% chance of it being permanent), injury to: foodpipe (esophagus), windpipe (trachea), arteries to the brain (carotid), spinal cord with paralysis, nerve root with paralysis, possible seizures with MEPs

Position

Supine, some use halter traction with this.

Equipment

a) microscope (not used by all surgeons)

b) C-arm

Implants

Graft (e.g. PEEK, cadaver bone, titanium cage…) and anterior cervical plate (optional, especially on single level ACDF).


Autologous bone (usually from iliac crest), non-autologous bone (cadaveric), bone substitutes (e.g. hydroxylapatite 1)) or synthetics (e.g. PEEK or titanium cage) filled with an osteogenic material. Substitutes for autologous bone eliminate problems with the donor site but may have a higher rate of absorption. There were also cases of HIV transmission from cadaveric bone grafts in 1985, however, as a result of the heightened awareness of AIDS since that time together with significant improvements in antibody testing and careful screening of donors, no further cases have been reported.

Anterior cervical plating

BMP

see BMP

Use of BMP in cervical interbody grafting

Current evidence does not support the routine use of rhBMP-2 for cervical arthrodesis (Level C Class II)19 (note: italics added. Use with precautions (see text) may be indicated in cases with high risk of nonunion).

Use of BMP in anterior cervical discectomies is not FDA approved but has been used off-label. Complication rates as high as 23–27% have been reported (including post-op swallowing or respiratory difficulties as a result of edema which is usually temporary) compared to 3 % without BMP.19 If used, it is recommended that a smaller dose be employed than in the lumbar spine (25% has been advocated) and to avoid contact of BMP with soft tissues in the neck.

Technique

Intraoperative neurophysiological monitoring

1)
Senter HJ, Kortyna R, Kemp WR. Anterior Cervical Discectomy with Hydroxylapatite Fusion. Neurosurgery. 1989; 25:39–43
anterior_cervical_discectomy_and_fusion_technique.txt · Last modified: 2019/09/25 18:07 by administrador