Surgery for anterior cervical fusion is performed with the patient lying on his or her back. A small incision is made in the front of the neck, to one side. After a retractor is used to pull aside fat and muscle, the disc is exposed between the vertebrae. Part of it is removed with a forceps. Then a surgical drill is used to enlarge the disc space, making it easier for the surgeon to empty the intervertebral space fully and remove any bone spurs. Afterwards, only a single ligament separates the surgical instruments from the spinal cord and nerve roots. A small section of bone is obtained from the patient's iliac crest (i.e. hip), through a separate incision and used as a bone graft. The bone graft is placed in the disc space, where it will begin to fuse the vertebrae it lies between. Placing a bone graft between the two vertebral bodies is done in order to create a fusion between these bones. The fusion is a direct result of the bone graft, but small, specialized metal plates are also placed on the front of the cervical spine in order to increase the stability of the spine immediately after the operation. Surgeons use cervical hardware to decrease the amount of time that you will have to wear a collar after surgery, and also to increase your chances of getting a solid fusion between the two vertebral bodies. The operation is completed when the neck incision is closed in several layers. Unless dissolving suture material is used, the skin sutures (stitches) or staples will have to be removed after the incision has healed.
Anterior cervical fusion is an operation performed on the upper spine to relieve pressure on one or more nerve roots, or on the spinal cord. The term is derived from the words anterior (front), cervical (neck), and fusion (joining the vertebrae with a bone graft). When an intervertebral disc ruptures in the cervical spine, it puts pressure on one or more nerve roots (often called nerve root compression) or on the spinal cord, causing pain and other symptoms in the neck, arms, and even legs. In this operation, the surgeon reaches the cervical spine through a small incision in the front of the neck. After the muscles of the spine are spread, the intervertebral disc is removed and a bone graft is placed between the two vertebral bodies. Over time, this bone graft will create a fusion between the vertebrae it lies between.
Cervical Laminoplasty
Its popularity in Japan arises from the formidable challenges of anterior decompression for ossification of the posterior longitudinal ligament. These anterior multilevel surgeries would be frequently complicated by dural tears as the dura is usually intimately associated with the ossified ligament. There was also a significant risk of instrumentation or graft failure. It has been reported that the rate of these complications including cerebrospinal fluid leakage and dislodgment or pseudarthrosis of the strut grafted bone was 24% and the rate of the salvage operation required was 12.5%. In the past, laminectomy has been the most common method to achieve posterior decompression of the cervical spine in these patients. However, the procedure has been complicated by postoperative instability resulting in deformity, particularly kyphosis, which may exacerbate neurological symptoms. Kyphosis and instability may leave the spine more vulnerable to cervical spine trauma, especially flexion injuries. In addition, postlaminectomy membranes have been implicated in arachnoiditis and restenosis after simple laminectomy. To avoid the disadvantages of laminectomy, several authors have described the technique of cervical laminoplasty whereby decompression is achieved without removal of the posterior spinal elements, maintaining the biomechanical integrity of the cervical spine and the spinal cord-protective features of the posterior elements. This is a more physiological solution. Expansive open-door laminoplasty was first described by Hirabayashi et al as a development of the air drill laminectomy technique of Kirita and has since been modified by Hirabayashi et al. and many others.
TDR for cervical spine
Initial surgical positioning was similar to that for a standard anterior cervical decompression and fusion. A roll was placed behind the shoulders and the head placed on a foam donut. The neck was extended slightly to facilitate exposure and an image intensifier was draped into the field. A transverse cervical incision was made in the neck over the C5-6 disc space and a standard extensile exposure of the C5-6 disc space was performed. Similarly routine discectomy was performed. The Bryan Cervical Disc System was utilized. The size of the implant (14 mm) and angle of the disc space was calculated precisely prior to placement of the implant. Using custom drill bits, and a milling wheel, a reciprocal concavity was cut into the endplates of C5 and C6. This is shown in Figures 4 and 5. After the endplates were precisely drilled and the decompression effected, the correct size prosthesis was placed into the defect (see Figure 6-9). At the completion of this stage closure was affected over a suction drain. The patient was transferred to the intensive care unit and extubated uneventfully.