DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Herniated cervical disk, C5-6, C6-7.
POSTOPERATIVE DIAGNOSIS: Herniated cervical disk, C5-6, C6-7.
OPERATION PERFORMED: Anterior cervical diskectomy and interbody fusion, C5-6 and C6-7 with allograft and plate fixation.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
TOTAL BLOOD LOSS: 100 mL.
FLUIDS RECEIVED: Approximately 1900 mL of crystalloids.
DRAINS: Jackson-Pratt drain placed.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was identified in the operating room, received 1 g of Ancef IV antibiotic preoperatively, and consented to anterior cervical diskectomy and interbody fusion of C5-6, C6-7 with allograft and plate fixation. After adequate anesthesia was achieved, with the patient in the supine position, a bolster was placed behind her shoulders. Cervical traction was applied of 5 pounds. All bony prominences were well padded. The area about the anterior neck was scrubbed, prepped, and draped in sterile fashion. The area of proposed right anterior transverse incision was infiltrated with 0.5% Marcaine with epinephrine solution.
A #10 blade was used to create an approximately 4 cm incision in the Langer line, right anterior, back to the neck. Subcutaneous tissue was dissected with Metzenbaum scissors. Hemostasis was obtained with bipolar electrocautery. Self-retaining retractor was placed. Fibers and fascia of the platysma incised along the length of fibers. A Kittner was used to bluntly dissect to the anterior surface of the cervical spine. A deep retractor was placed and image intensification used to target the appropriate disk spaces. Procedure, described per C5-6 level, it was repeated at C6-7. Anterior annulotomy performed with Bovie. Cobb elevator was used to provisionally denude the articular cartilage from the vertebral endplates with care taken not to anteriorly weaken the subchondral bone. Disk material was removed using pituitary forceps carefully and seated posteriorly to posterior longitudinal ligament. This was gently elevated with curette and then excised with 1 mm Kerrison. The ligaments were identified and protected. After removal of disk and ligament, nerve hook was used to ensure that the foramina were widely patent and no fragments were retained within the canal.
Anterior osteophytes were removed with the cervical traction applied. Disk space was measured to height and depth. At the C5-6 level, a 6 mm trial was placed, which fit well at the C6-7 level. A 7 mm trial likewise fit well. A 6 mm grip placed at C5-6, a 7 mm grip placed at C6-7, and then impacted into place at each level. The graft countersunk into the interspace and locked in. Traction was released. Grafts could not easily be removed using a Kocher clamp. Posterior margins of the graft were palpable and found not to protrude too far posteriorly. Plate of appropriate size was chosen, bent to approximate with that of curvature of the cervical spine at these levels and fixed using 12 mm screws placed in standard AO fashion. Each screw was countersunk into the plate and torqued nicely. The construct appeared very solid.
AP and lateral radiographs revealed good placement of graft and hardware. Incision was copiously irrigated, 3-0 Vicryl suture used, and Hemovac. A Jackson-Pratt drain was placed. A 3-0 Vicryl suture was used to approximate the fascia, platysma, and subdermal layer and 5-0 nylon suture was used to approximate the skin. Sterile dressing and Philadelphia collar applied. The patient tolerated the procedure well. He was taken to the recovery room in stable condition.
