Less exposure surgery for multilevel anterior cervical fusion using 2 transverse incisions

Technical note

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Multilevel anterior cervical fusion often necessitates a large extensile incision for exposure and substantial retraction of the esophagus for placing long plates, potentially predisposing patients to complications such as dysphagia, dysphonia, and neurovascular injury. To the authors' knowledge, the use of 2 incisions as an option has not been published, and so it is not intuitive to young surgeons or widely practiced. In this report, the authors discuss the advantages and raise awareness of using 2 incisions for multilevel anterior cervical fusion, and they document a safe skin bridge length. They also describe the advantages of using 2 incisions for performing multilevel anterior cervical fusion either at contiguous or noncontiguous levels as in adjacent-segment disease. By using the 2-incision technique, the authors made the surgery technically easier and diminished the amount of esophageal retraction otherwise needed through 1 long transverse or longitudinal incision. A skin bridge of 3 cm was safe.

Abbreviation used in this paper:ACDF = anterior cervical discectomy and fusion.

Article Information

Current affiliation for Dr. Ricchetti: Cleveland Clinic, Cleveland, Ohio.

Address correspondence to: Kingsley R. Chin, M.D., 1100 West Oakland Park Boulevard, Suite 3, Fort Lauderdale, Florida 33480. email: kingsleychin@gmail.com.

Please include this information when citing this paper: published online July 6, 2012; DOI: 10.3171/2012.5.SPINE111112.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 1. Lateral plain radiograph of the cervical spine demonstrating a C4–6 fusion with adjacent-segment disease at C3–4 and C6–7.

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    Case 1. Intraoperative photographs of the planned anterior incisions. The skin bridge measured 3 cm between the 2 incisions.

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    Case 1. Six-week postoperative lateral plain radiograph of the cervical spine showing fusion from C-3 to C-7.

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    Case 2. Sagittal reconstructed CT scans of the cervical spine demonstrating degenerative disc disease at C3–4, with severe degeneration and kyphosis at C6–7 in a patient after laminectomies at C3–6.

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    Case 2. Postoperative lateral radiograph of the cervical spine showing fusion at C3–4 with anterior plating, and posterior instrumented fusion from C-3 to T-3 using C3–5 lateral mass screws and C7–T3 pedicle screws (not clearly visualized).

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    Intraoperative image showing a 3-level ACDF performed with the 2-incision technique. Using this approach, both ends of the anterior cervical plate are well visualized simultaneously to ensure correct placement.

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