DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Herniated disk, C6-7.
POSTOPERATIVE DIAGNOSIS: Herniated disk, C6-7.
OPERATIONS PERFORMED:
1. Anterior cervical diskectomy, C6-7.
2. Anterior interbody fusion, C6-7.
3. Anterior fixation using the Theken anterior cervical plate.
4. Harvest, left iliac crest bone graft.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, PA-C
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 150 mL.
NEEDLE AND SPONGE COUNTS: Correct.
DRAINS AND PACKS: 15-French Silastic drain.
SPECIMENS: None.
MATERIALS: 4-0 Vicryl, subcuticular.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and given a general endotracheal anesthetic while lying face up on the operating table. A roll was placed behind the shoulders and the arms tucked in the side, and the shoulders gently pulled down and taped to facilitate intraoperative x-rays. Sterile prep was done of the patient’s neck with Betadine along with left iliac crest. The patient was draped in a sterile manner.
Anterior approach was performed from the right hand side at the C6-7 level. Carotid tubercle of C6 vertebra was easily palpable. The carotid artery was identified and retracted laterally. The esophagus tracked medially in the midline, and the cervical spine was palpated. An x-ray was taken, and the needle was placed in the C5-6 disk space. This was done because it was feared that we would not be able to see the C6-7 level. Needle was found to be at the appropriate level. The longus colli muscles were reflected off anteriorly to expose the C6-7 disk.
Self-retaining retractors were placed behind them. Distraction pins were placed into the bodies of C6 and C7 for longitudinal distraction. The anterior annulus was excised. The contents of the disk were then removed with periosteal elevator, curette, and pituitaries. The defect in the posterior annulus was identified and enlarged with a 2 mm Kerrison rongeur. A small nerve hook was used to tease the fragment of disk up into view, and this was removed and larger fragment, even deeper in, was grasped with the micropituitary and removed. The cavity that remained was carefully explored. No other fragments were found. A little bit of uncovertebral joint was removed to allow for further exploration, again no other fragments were found.
The disk space was then prepared for fusion by burring the end plates to a parallel 8 mm gap. Iliac crest was harvested from the left anterior iliac crest by routine exposure and harvesting a tricortical piece of bone with a double blade 8 mm oscillating saw. This was fashioned to appropriate depth. The edge was gently chamfered with a bur to allow it to seat neatly in the disk space. Distraction was placed into the disk space. Distraction was removed, and the graft was held tightly between the two vertebrae.
The wound had been irrigated well prior to this. It was irrigated out once again and then an 18 mm plate from the Theken cervical plate system was selected and found to be the appropriate length. It was bent slightly to facilitate approximation to the anterior vertebrae. The plate was then centered, the holes drilled, and 13 mm self-tapping screws were placed. Locking mechanism engaged nicely at all levels. The wound was irrigated out a final time, a 15 French Silastic drain placed, and then the wound was closed with 2-0 Vicryl and 4-0 Vicryl. The donor site was closed with 0-Vicryl, 2-0 Vicryl, and 4-0 Vicryl. Steri-Strips were applied to all wounds. Dry dressing was placed. Drain noted to dissection. A soft collar was placed. The patient was awakened, extubated, and taken to the recovery room in stable condition.
