Hello this is doctor corenman we’re going to go through a tutorial and animation of an anterior cervical decompression and fusion C six seven here you see a side view xray lateral xray where there’s an angulation and here you see the MRI with the herniation at the base of the spine this is a normal level transversely and the next picture will be the hernaited disc where you see it’s compressing both the cord as well as the two holes the nerves exit we first start with a small transverse incision on the side of the neck point.
And we disect directly onto the anterior part of the neck we put in these two small distraction pins called caspar pins that allows us to pull the vertebra apart to its normal height typically these vertebra have collapsed at least half way this is a picture of what the annulus itself looks like in a live tutorial you can see this little penfield going into the tear that tear obviously should be attached to that vertebra but this patient has torn off their annulus we then take off the anterior aspect.
Of the annulus and this tutorial depicts how it’s done in a simple matter and we’ll see how we do it using a typical eleven blade here is the little tiny scalpel that goes in and removes this annulus the nucleus is missing in this patient it had actually dissolved away and the rest of it went to the back of the neck compressing the nerves here we see a small tool removing this portion of the annulus we then remove the spurs on the front portion of the neck so we can get the two vertebra parallel.
Anterior Cervical Decompression and Fusion ACDF Live Spine Surgery Tutorial Spine Surgeon
And have a good spot to dock our plate in addition it allows us to be able to know the depth of the graft that we need here we see a burr taking off theses spurs once we have the spurs in the front removed we then need to remove the spurs that occur within the disc itself and we see this little dremel type device the burr removing that bone and here we see a live version of the same thing where the burr actually takes the spur off the bone.
And we need to have the end plates parallel because the end plates in a typical cervical vertebra have some curve to them and in order to be accepting of a good placement of a graft we have to take these end plates down we then curette the cartilage that sits on each end plate and here we see the curette taking off this cartilage this cartilage itself prevents boney fusion and must be thoroughly removed to prepare the end plates to accept the bone graft in addition the cartilage hides the bone spurs.
That project into the back of the canal and we want to have those removed so here we see removal of that cartilage using a pituitary we then work on the back spurs that are projecting into the canal and we use a small tool called a kerrison as well as a curette the uncovered campbell joints are the areas of the bone that create the spurs that compress the nerves and here you see them removed with the kerrison the kerrison will remove these and make more room for the nerve which you can see in.
The background there you can also removed the spurs with the highspeed burr as we see here and this thins down those spurs enough that you can usually pull them into the disc space using a small up angled curette also we see the end plate being paralyzed here’s the finished product so to speak we irrigate to make sure and wash out any debri and then we check for the height of the graft that is necessary and we will use this little device you’ll see being pushed in there.
It expands the vertebrates not perfectly ready so a little more trim little more parallelization and then we’ll put that spacer in and you’ll see the spacer fits quite nicely we know we’re ready for the graft we prepare the graft it could be in auto graft from the patient themselves orn allo graft in this case will use an auto graft this is a device that measures the depth of the hole and then what we’ll do is take a graft as depicted in this animation and place it between the two vertebra.
Here we see a graft with a little purple and i actually dye the front of the graft purple to keep a good spot on it and we place it within the disc space that was the initial impaction and we do our final impaction and this is how a graft should look it should be perfectly inter digitated between the two vertebra and fit quite nicely as you see we then take a small titanium plate and that plate will be put on the front to cover this graft to stabilize it.
And to allow the patient to get out of a collar much more quickly than normally these green screws you see look to be quite big but they are actually small there’s significant magnification from the microscope that makes these screws look larger than they really are once the screws are placed then we tighten down this swage screw which attachs the screws to the plate itself and that’s that cross hatch screw you see in the center we will shortly tighten that and there we tighten those screws to swage them down.