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

Technical note

Restricted access

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

Contributor Notes

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.
Headings
References
  • 1

    Albert TJMurrell SE: Surgical management of cervical radiculopathy. J Am Acad Orthop Surg 7:3683761999

  • 2

    Auerbach JDJones KJFras CIBalderston JRRushton SAChin KR: The prevalence of indications and contraindications to cervical total disc replacement. Spine J 8:7117162008

    • Search Google Scholar
    • Export Citation
  • 3

    Berger RA: The technique of minimally invasive total hip arthroplasty using the two-incision approach. Instr Course Lect 53:1491552004

    • Search Google Scholar
    • Export Citation
  • 4

    Berger RA: Total hip arthroplasty using the minimally invasive two-incision approach. Clin Orthop Relat Res 417:2322412003

  • 5

    Berger RADuwelius PJ: The two-incision minimally invasive total hip arthroplasty: technique and results. Orthop Clin North Am 35:1631722004

    • Search Google Scholar
    • Export Citation
  • 6

    Bohlman HHEmery SEGoodfellow DBJones PK: Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 75:129813071993

    • Search Google Scholar
    • Export Citation
  • 7

    Chin KRAhn J: Controlled cervical extension osteotomy for ankylosing spondylitis utilizing the Jackson operating table: technical note. Spine (Phila Pa 1976) 32:192619292007

    • Search Google Scholar
    • Export Citation
  • 8

    Chin KRAuerbach JDAdams SB JrSodl JFRiew KD: Mastication causing segmental spinal motion in common cervical orthoses. Spine (Phila Pa 1976) 31:4304342006

    • Search Google Scholar
    • Export Citation
  • 9

    Chin KREiszner JRAdams SB Jr: Role of plate thickness as a cause of dysphagia after anterior cervical fusion. Spine (Phila Pa 1976) 32:258525902007

    • Search Google Scholar
    • Export Citation
  • 10

    Duwelius PJ: Two-incision minimally invasive total hip arthroplasty: techniques and results to date. Instr Course Lect 55:2152222006

    • Search Google Scholar
    • Export Citation
  • 11

    Emery SE: Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg 9:3763882001

  • 12

    Emery SEBohlman HHBolesta MJJones PK: Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up. J Bone Joint Surg Am 80:9419511998

    • Search Google Scholar
    • Export Citation
  • 13

    Holly LTMoftakhar PKhoo LTWang JCShamie N: Minimally invasive 2-level posterior cervical foraminotomy: preliminary clinical results. J Spinal Disord Tech 20:20242007

    • Search Google Scholar
    • Export Citation
  • 14

    Riew KDCheng IPimenta LTaylor B: Posterior cervical spine surgery for radiculopathy. Neurosurgery 60:1 Suppl 1S57S632007

  • 15

    Santiago PFessler RG: Minimally invasive surgery for the management of cervical spondylosis. Neurosurgery 60:1 Suppl 1S160S1652007

    • Search Google Scholar
    • Export Citation
  • 16

    Sehati NKhoo LT: Minimally invasive posterior cervical arthrodesis and fixation. Neurosurg Clin N Am 17:4294402006

  • 17

    Song JKChristie SD: Minimally invasive cervical stenosis decompression. Neurosurg Clin N Am 17:4234282006

TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 316 255 48
Full Text Views 126 52 2
PDF Downloads 214 43 2
EPUB Downloads 0 0 0
PubMed
Google Scholar