Surgical anatomy of microsurgical 3-level anterior cervical discectomy and fusion C4–C7

Domagoj Gajski; Alicia R. Dennis; Kenan I. Arnautovic

doi:10.17305/bjbms.2020.4895

Authors

Domagoj Gajski Department of Neurosurgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Zagreb, Croatia https://orcid.org/0000-0002-2517-5726
Alicia R. Dennis Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States https://orcid.org/0000-0003-2770-1715
Kenan I. Arnautovic Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States https://orcid.org/0000-0003-3745-288X

DOI:

https://doi.org/10.17305/bjbms.2020.4895

Keywords:

Anterior cervical spine, ACDF, discectomy, fusion, allograft

Abstract

Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures, frequently used for the treatment of cervical spine degenerative diseases. It was first described in 1958. Interestingly, to our knowledge, 3-level ACDF has not been previously published as a peer-reviewed video case with a detailed description of intraoperative microsurgical anatomy. In this video, we present the case of a 33-year-old male who presented with a combination of myelopathy (hyperreflexia and long tract signs in the upper and lower extremities) and bilateral radiculopathy of the upper extremities. He had been previously treated conservatively with physical therapy and pain management for 6 months without success. We performed 3-level microsurgical ACDF from C4 to C7. All 3 levels were decompressed, and bone allografts were placed to achieve intervertebral body fusion. A titanium plate was utilized from C4 to C7 for internal fixation. The patient was discharged home on the first postoperative day. His pain, numbness and tingling resolved, as well as his myelopathy. No perioperative complications were encountered. Herein we present the surgical anatomy of our operative technique including ertain technical tips. Written consent was obtained directly from the patient.

VIDEO
https://vimeo.com/user128225853

VIDEO ANNOTATIONS
01:13 — opening the surgery site
02:29 — positioning of retractors
03:02 — start of 3-level discectomy
06:04 — allograft placement and fixation
08:20 — drain placement and closure