Remove entire disk including cartilage endplates to reveal cortical bone
11. Remove ligamentous tissue front to back to allow access to spinal canal
12. Insert bone graft and implant cage into evacuated space
13. Attach small plate to front of spine with screws in each vertebral bone (see ▶Fig. 1.2 to ▶Fig. 1.4)
14. Clean surgical site, exit, and suture
15. If posterior approach is needed, place the patient prone with Mayfield head pins with all pressure points padded
16. Dissect to lamina over affected levels and confirm levels on X-ray
17. Perform laminectomy and foraminotomies over affected levels that are stenotic and place lateral mass screws with rods and bone graft if needed over affected levels for fusion
18. Obtain hemostasis, place drain, and close wound in multiple layers
Pitfalls
• Loss of neck mobility by ~30%
• Intraoperative cerebrospinal fluid (CSF) leak
Fig. 1.2 (a, b) Cord decompression, corpectomy (C5), and fusion (C4–C6) were performed. The fusion healed within one year. (Source: Diagnostic Features. In: Vialle L, ed. AOSpine Masters Series, Volume 5: Cervical Spine Trauma. 1st ed. Thieme; 2015).
Fig. 1.3 (a–d) A patient suffered cervical trauma resulting in C3/C4 dislocation. Fusion (C3–C4) was performed and lateral mass screw placement was verified using X-ray and CT scan. (Source: Cervical case studies. In: Perez-Cruet M, Fessler R, Wang M, eds. An Anatomic Approach to Minimally Invasive Spine Surgery. 2nd ed. Thieme; 2018).
• Blood clot (deep vein thrombosis, or more severe pulmonary embolism)
• Damage to spinal nerves and/or cord
• Postoperative weakness or numbness or continued pain
• Postoperative wound infection
• Continued symptoms postsurgically/unresolved symptoms with no improvement to quality of life
Fig. 1.4 A man suffered cervical trauma after a bicycle accident, resulting in traumatic disk herniation. Radiology revealed associated cord contusion and C3–C4 instability. Fusion (C3–C4) was performed and after therapy, his paresis reduced. (Source: Brembilla C, Lanterna L, Gritti P, et al. The use of a stand-alone interbody fusion cage in subaxial cervical spine trauma: a preliminary report. J Neurol Surg A Cent Eur Neurosurg 2015;76(01):13–19).
Prognosis
• Most patient are hospitalized for 1 to 2 days, then return home with strict orders of minimal sudden head/neck movement
• Typically, 4 to 6 weeks post operation most patients are able to return to normal day-to-day activities
• Full fusion (formation of hard bone) may take 12 to 18 months
• Physical therapy (PT) and occupational therapy (OT) should strongly be considered
1.2 Elective
1.2.1 Anterior Cervical Fusion/Posterior Cervical Fusion
Indications
• No complete arch of C1
• Bursting C1 fracture
• Congenital abnormalities
• Odontoid movement into foramen magnum
• Vertebral shifts
Symptoms and Signs
• Stiff neck
• Sharp pinpoint pain in neck
• Soreness lasting >7 days
• Weakness in neck muscle
• Tingling/Numbness in general neck area
• Trouble gripping objects
• Tingling in finger tips
• Frequent tension headaches (~4+ days per week)
Surgical Pathology
• Spondylosis
• Spondylosis
• Adjacent segment pathology (ASP)
• Radiculopathy (see ▶Fig. 1.5)
• Osteomyelitis
• Vertebral body tumors
• Myelopathy (see ▶Fig. 1.6 and ▶Fig. 1.7)
• Postlaminectomy kyphosis (see ▶Fig. 1.8)
• Opacified posterior longitudinal ligament
Fig. 1.5 (a, b) An elderly woman with neck pain and deformity from myelopathy received posterior decompression (C3–C6), anterior diskectomy and fusion (C4–C5), and posterior fusion (C2–T2). A transition rod was added for stabilization. (Source: Radiographic considerations. In: Ames C, Riew K, Abumi K, eds. Cervical Spine Deformity Surgery. 1st ed. Thieme; 2019).
Fig. 1.6 (a, b) An elderly man with chin-on-chest deformity (kyphosis) received anterior and posterior
