Cervical Arthrodesis

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Cervical disc disease
  • Cervical spondylosis with or without myelopathy
  • Unstable cervical fractures
  • Cervical instability from other causes:
    • Rheumatoid arthritis
    • Traumatic quadriparesis
    • Neoplastic spinal metastasis
    • Congenital abnormalities
CONTRAINDICATIONS

There are no absolute contraindications to this procedure.

EQUIPMENT
  • Operating microscope
  • High-speed bur
  • Small-angled curets
  • Small Kerrison rongeurs
  • Micro-blunt hook
  • Micro-blunt dissector
  • Blunt hand-held retractors
  • Bipolar electrocautery
  • Distraction pins
  • Self-retaining retractor
  • No. 11 blade scalpel
  • Pituitary rongeurs
  • Curets
  • Kocher clamp
  • Small oscillating saw
  • Bone wax
ANATOMY
  • Surface anatomy
    • Hyoid bone (C3), thyroid cartilage (C4-C5), cricoid cartilage (C6)
  • Muscles encountered in the dissection:
    • Platysma, sternocleidomastoid, omohyoid, longus colli, digastric, stylohyoid
  • Neurovascular structures at risk:
    • Carotid artery, sympathetic ganglia, recurrent laryngeal nerve, superior laryngeal nerve, hypoglossal nerve, pharyngeal and laryngeal branches of the vagus nerve

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
TECHNIQUES
  • Post-Procedure: Anterior Cervical Arthrodesis (Smith-Robinson Technique)
  • Post-Procedure: Anterior Cervical Arthrodesis (Bailey and Badgley Technique)
  • Post-Procedure: Anterior Cervical Arthrodesis (Simmons' Technique)
  • Post-Procedure: Anterior Occipitocervical Arthrodesis by Extrapharyngeal Exposure (deAndrade and Macnab Technique)
  • Post-Procedure: Anterior Occipitocervical Arthrodesis by Extrapharyngeal Exposure (Robinson and Riley Technique)

Post-Procedure: Anterior Cervical Arthrodesis (Smith-Robinson Technique)

POST-PROCEDURE CARE
  • Remove drain on postoperative day 1.
  • Bracing and mobilization vary by technique:
    • Smith-Robinson or Simmons' technique: rigid cervical orthosis for 4 to 6 weeks (discectomy) or 8 to 12 weeks (corpectomy); soft cervical collar for an additional 1 to 2 weeks.
    • Discontinue orthosis when fusion visible on radiographs.
    • Bailey and Badgley technique: halo brace for 3 months followed by 4 to 6 weeks in a cervical collar.
  • Early patient mobilization is allowed on the surgical day or postoperative day 1.
  • If fibular strut grafting is used, postoperative immobilization may need to be prolonged.
COMPLICATIONS
  • Spinal cord injury
  • Other neurologic injury (recurrent laryngeal nerve)
  • Dural tears
  • Fusion of incorrect vertebral level
  • Sympathetic nervous system injury
  • Dysphagia
  • Dysphonia
  • Airway obstruction secondary to the development of a retropharyngeal hematoma
  • Vertebral body collapse (seen most often with multilevel dowel technique, which is no longer used)
  • Pseudarthrosis
ANALYSIS OF RESULTS
  • Anterior cervical fusion has shown good results with all of the techniques described; Smith-Robinson technique strongest in terms of compressive load.
  • Complication rates are generally low; most common are nerve injury and pseudarthrosis.
  • Pseudarthrosis rates are reduced by using internal fixation.
OUTCOMES AND EVIDENCE
  • Apfelbaum et al: laryngeal nerve compression may be caused by endotracheal tube position combined with tracheal retraction; the incidence was decreased by deflating and reinflating the endotracheal tube cuff after retractor placement.
  • One prospective study reported a 50% frequency of dysphagia at 1 month after surgery; at 6 months, only 4.8% had moderate to severe dysphagia.
  • Dysphonia has been reported to be around 4% to 5%.
  • With multilevel interbody fusions, the pseudarthrosis rate increases nonlinearly.
  • Wang et al: the addition of internal fixation for two-level anterior cervical discectomy and fusion significantly reduced the pseudarthrosis rate.
  • In another study, there was no difference in fusion rates between single-level cervical corpectomy and two-level discectomy and fusion when anterior plating was used.
  • Smoking has been shown to increase the pseudarthrosis rate following posterolateral lumbar grafting.
  • Hilibrand et al: smoking had a negative impact on healing after multilevel anterior fusion with autogenous interbody graft without internal fixation. No difference was seen when corpectomy was done.
  • Bose et al: no difference in fusion rates between smokers and nonsmokers for multilevel anterior cervical decompression and fusion when anterior plating was used.
  • White et al: Robinson and Smith configuration is the strongest in compressive loading.
Procedure: Anterior Cervical Arthrodesis (Smith-Robinson Technique)

Post-Procedure: Anterior Cervical Arthrodesis (Bailey and Badgley Technique)

POST-PROCEDURE CARE
  • Remove drain on postoperative day 1.
  • Bracing and mobilization vary by technique:
    • Smith-Robinson or Simmons' technique: rigid cervical orthosis for 4 to 6 weeks (discectomy) or 8 to 12 weeks (corpectomy); soft cervical collar for an additional 1 to 2 weeks.
    • Discontinue orthosis when fusion visible on radiographs.
    • Bailey and Badgley technique: halo brace for 3 months followed by 4 to 6 weeks in a cervical collar.
  • Early patient mobilization is allowed on the surgical day or postoperative day 1.
  • If fibular strut grafting is used, postoperative immobilization may need to be prolonged.
COMPLICATIONS
  • Spinal cord injury
  • Other neurologic injury (recurrent laryngeal nerve)
  • Dural tears
  • Fusion of incorrect vertebral level
  • Sympathetic nervous system injury
  • Dysphagia
  • Dysphonia
  • Airway obstruction secondary to the development of a retropharyngeal hematoma
  • Vertebral body collapse (seen most often with multilevel dowel technique, which is no longer used)
  • Pseudarthrosis
ANALYSIS OF RESULTS
  • Anterior cervical fusion has shown good results with all of the techniques described; Smith-Robinson technique strongest in terms of compressive load.
  • Complication rates are generally low; most common are nerve injury and pseudarthrosis.
  • Pseudarthrosis rates are reduced by using internal fixation.
OUTCOMES AND EVIDENCE
  • Apfelbaum et al: laryngeal nerve compression may be caused by endotracheal tube position combined with tracheal retraction; the incidence was decreased by deflating and reinflating the endotracheal tube cuff after retractor placement.
  • One prospective study reported a 50% frequency of dysphagia at 1 month after surgery; at 6 months, only 4.8% had moderate to severe dysphagia.
  • Dysphonia has been reported to be around 4% to 5%.
  • With multilevel interbody fusions, the pseudarthrosis rate increases nonlinearly.
  • Wang et al: the addition of internal fixation for two-level anterior cervical discectomy and fusion significantly reduced the pseudarthrosis rate.
  • In another study, there was no difference in fusion rates between single-level cervical corpectomy and two-level discectomy and fusion when anterior plating was used.
  • Smoking has been shown to increase the pseudarthrosis rate following posterolateral lumbar grafting.
  • Hilibrand et al: smoking had a negative impact on healing after multilevel anterior fusion with autogenous interbody graft without internal fixation. No difference was seen when corpectomy was done.
  • Bose et al: no difference in fusion rates between smokers and nonsmokers for multilevel anterior cervical decompression and fusion when anterior plating was used.
  • White et al: Robinson and Smith configuration is the strongest in compressive loading.
Procedure: Anterior Cervical Arthrodesis (Bailey and Badgley Technique)

Post-Procedure: Anterior Cervical Arthrodesis (Simmons' Technique)

POST-PROCEDURE CARE
  • Remove drain on postoperative day 1.
  • Bracing and mobilization vary by technique:
    • Smith-Robinson or Simmons' technique: rigid cervical orthosis for 4 to 6 weeks (discectomy) or 8 to 12 weeks (corpectomy); soft cervical collar for an additional 1 to 2 weeks.
    • Discontinue orthosis when fusion visible on radiographs.
    • Bailey and Badgley technique: halo brace for 3 months followed by 4 to 6 weeks in a cervical collar.
  • Early patient mobilization is allowed on the surgical day or postoperative day 1.
  • If fibular strut grafting is used, postoperative immobilization may need to be prolonged.
COMPLICATIONS
  • Spinal cord injury
  • Other neurologic injury (recurrent laryngeal nerve)
  • Dural tears
  • Fusion of incorrect vertebral level
  • Sympathetic nervous system injury
  • Dysphagia
  • Dysphonia
  • Airway obstruction secondary to the development of a retropharyngeal hematoma
  • Vertebral body collapse (seen most often with multilevel dowel technique, which is no longer used)
  • Pseudarthrosis
ANALYSIS OF RESULTS
  • Anterior cervical fusion has shown good results with all of the techniques described; Smith-Robinson technique strongest in terms of compressive load.
  • Complication rates are generally low; most common are nerve injury and pseudarthrosis.
  • Pseudarthrosis rates are reduced by using internal fixation.
OUTCOMES AND EVIDENCE
  • Apfelbaum et al: laryngeal nerve compression may be caused by endotracheal tube position combined with tracheal retraction; the incidence was decreased by deflating and reinflating the endotracheal tube cuff after retractor placement.
  • One prospective study reported a 50% frequency of dysphagia at 1 month after surgery; at 6 months, only 4.8% had moderate to severe dysphagia.
  • Dysphonia has been reported to be around 4% to 5%.
  • With multilevel interbody fusions, the pseudarthrosis rate increases nonlinearly.
  • Wang et al: the addition of internal fixation for two-level anterior cervical discectomy and fusion significantly reduced the pseudarthrosis rate.
  • In another study, there was no difference in fusion rates between single-level cervical corpectomy and two-level discectomy and fusion when anterior plating was used.
  • Smoking has been shown to increase the pseudarthrosis rate following posterolateral lumbar grafting.
  • Hilibrand et al: smoking had a negative impact on healing after multilevel anterior fusion with autogenous interbody graft without internal fixation. No difference was seen when corpectomy was done.
  • Bose et al: no difference in fusion rates between smokers and nonsmokers for multilevel anterior cervical decompression and fusion when anterior plating was used.
  • White et al: Robinson and Smith configuration is the strongest in compressive loading.
Procedure: Anterior Cervical Arthrodesis (Simmons' Technique)

Post-Procedure: Anterior Occipitocervical Arthrodesis by Extrapharyngeal Exposure (deAndrade and Macnab Technique)

POST-PROCEDURE CARE
  • Remove drain on postoperative day 1.
  • Bracing and mobilization vary by technique:
    • Smith-Robinson or Simmons' technique: rigid cervical orthosis for 4 to 6 weeks (discectomy) or 8 to 12 weeks (corpectomy); soft cervical collar for an additional 1 to 2 weeks.
    • Discontinue orthosis when fusion visible on radiographs.
    • Bailey and Badgley technique: halo brace for 3 months followed by 4 to 6 weeks in a cervical collar.
  • Early patient mobilization is allowed on the surgical day or postoperative day 1.
  • If fibular strut grafting is used, postoperative immobilization may need to be prolonged.
COMPLICATIONS
  • Spinal cord injury
  • Other neurologic injury (recurrent laryngeal nerve)
  • Dural tears
  • Fusion of incorrect vertebral level
  • Sympathetic nervous system injury
  • Dysphagia
  • Dysphonia
  • Airway obstruction secondary to the development of a retropharyngeal hematoma
  • Vertebral body collapse (seen most often with multilevel dowel technique, which is no longer used)
  • Pseudarthrosis
ANALYSIS OF RESULTS
  • Anterior cervical fusion has shown good results with all of the techniques described; Smith-Robinson technique strongest in terms of compressive load.
  • Complication rates are generally low; most common are nerve injury and pseudarthrosis.
  • Pseudarthrosis rates are reduced by using internal fixation.
OUTCOMES AND EVIDENCE
  • Apfelbaum et al: laryngeal nerve compression may be caused by endotracheal tube position combined with tracheal retraction; the incidence was decreased by deflating and reinflating the endotracheal tube cuff after retractor placement.
  • One prospective study reported a 50% frequency of dysphagia at 1 month after surgery; at 6 months, only 4.8% had moderate to severe dysphagia.
  • Dysphonia has been reported to be around 4% to 5%.
  • With multilevel interbody fusions, the pseudarthrosis rate increases nonlinearly.
  • Wang et al: the addition of internal fixation for two-level anterior cervical discectomy and fusion significantly reduced the pseudarthrosis rate.
  • In another study, there was no difference in fusion rates between single-level cervical corpectomy and two-level discectomy and fusion when anterior plating was used.
  • Smoking has been shown to increase the pseudarthrosis rate following posterolateral lumbar grafting.
  • Hilibrand et al: smoking had a negative impact on healing after multilevel anterior fusion with autogenous interbody graft without internal fixation. No difference was seen when corpectomy was done.
  • Bose et al: no difference in fusion rates between smokers and nonsmokers for multilevel anterior cervical decompression and fusion when anterior plating was used.
  • White et al: Robinson and Smith configuration is the strongest in compressive loading.
Procedure: Anterior Occipitocervical Arthrodesis by Extrapharyngeal Exposure (deAndrade and Macnab Technique)

Post-Procedure: Anterior Occipitocervical Arthrodesis by Extrapharyngeal Exposure (Robinson and Riley Technique)

POST-PROCEDURE CARE
  • Remove drain on postoperative day 1.
  • Bracing and mobilization vary by technique:
    • Smith-Robinson or Simmons' technique: rigid cervical orthosis for 4 to 6 weeks (discectomy) or 8 to 12 weeks (corpectomy); soft cervical collar for an additional 1 to 2 weeks.
    • Discontinue orthosis when fusion visible on radiographs.
    • Bailey and Badgley technique: halo brace for 3 months followed by 4 to 6 weeks in a cervical collar.
  • Early patient mobilization is allowed on the surgical day or postoperative day 1.
  • If fibular strut grafting is used, postoperative immobilization may need to be prolonged.
COMPLICATIONS
  • Spinal cord injury
  • Other neurologic injury (recurrent laryngeal nerve)
  • Dural tears
  • Fusion of incorrect vertebral level
  • Sympathetic nervous system injury
  • Dysphagia
  • Dysphonia
  • Airway obstruction secondary to the development of a retropharyngeal hematoma
  • Vertebral body collapse (seen most often with multilevel dowel technique, which is no longer used)
  • Pseudarthrosis
ANALYSIS OF RESULTS
  • Anterior cervical fusion has shown good results with all of the techniques described; Smith-Robinson technique strongest in terms of compressive load.
  • Complication rates are generally low; most common are nerve injury and pseudarthrosis.
  • Pseudarthrosis rates are reduced by using internal fixation.
OUTCOMES AND EVIDENCE
  • Apfelbaum et al: laryngeal nerve compression may be caused by endotracheal tube position combined with tracheal retraction; the incidence was decreased by deflating and reinflating the endotracheal tube cuff after retractor placement.
  • One prospective study reported a 50% frequency of dysphagia at 1 month after surgery; at 6 months, only 4.8% had moderate to severe dysphagia.
  • Dysphonia has been reported to be around 4% to 5%.
  • With multilevel interbody fusions, the pseudarthrosis rate increases nonlinearly.
  • Wang et al: the addition of internal fixation for two-level anterior cervical discectomy and fusion significantly reduced the pseudarthrosis rate.
  • In another study, there was no difference in fusion rates between single-level cervical corpectomy and two-level discectomy and fusion when anterior plating was used.
  • Smoking has been shown to increase the pseudarthrosis rate following posterolateral lumbar grafting.
  • Hilibrand et al: smoking had a negative impact on healing after multilevel anterior fusion with autogenous interbody graft without internal fixation. No difference was seen when corpectomy was done.
  • Bose et al: no difference in fusion rates between smokers and nonsmokers for multilevel anterior cervical decompression and fusion when anterior plating was used.
  • White et al: Robinson and Smith configuration is the strongest in compressive loading.
Procedure: Anterior Occipitocervical Arthrodesis by Extrapharyngeal Exposure (Robinson and Riley Technique)
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