Anterior Cervical Decompression and Fusion (ACDF) | Live Spine Surgery Video | Spine Surgeon

hello this is doctor corenman we’re going
to go through a video and animation of an anterior cervical decompression
and fusion C six seven here you see a side view x-ray
lateral x-ray 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 video 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 video 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 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
high-speed 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 that the post operative x-ray from front
to back view and a side view noting the position of
the plate and the incorporation of the graft thank you for your attention

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