Spine Resident Curriculum - ACDF (Anterior Cervical Discectomy and Fusion)

Description

A surgical procedure is performed by Dr. Sokunbi, a spine surgeon from HSS (Hospital for Special Surgery), focusing on an Anterior Cervical Discectomy and Fusion (ACDF) at the C4-C5 vertebral level. The patient is a 55-year-old female suffering from neck and arm pain attributed to spondylosis and disc space collapse, having previously failed conservative treatment options.



The procedure begins with detailed imaging analysis showcasing the patient's cervical spine condition, highlighting the spondylosis primarily affecting the C4-C5 levels, with significant disc collapse and neurological implications. The planned surgical approach involves a complete discectomy, where the degenerated disc will be removed entirely, followed by the insertion of a titanium cage packed with allograft bone to facilitate fusion between vertebrae.



The surgery involves careful dissection through anatomical structures to access the cervical spine, managing bleeding and ensuring the safety of surrounding tissues such as the carotid sheath and esophagus. Utilizing tools like the Bovie electrocautery for coagulation and Metzenbaum scissors for dissection, Dr. Sokunbi methodically prepares the area and visualizes critical landmarks using retractors and microscopy.



In the procedure, significant focus is placed on maintaining the integrity of the spinal cord and surrounding structures while removing disc material and achieving adequate decompression. The protocol emphasizes the importance of neuromonitoring to ensure no change occurs in motor signals during critical stages of the surgery.



After the discectomy, the implantation of the titanium cage is confirmed under fluoroscopy, followed by placement of a titanium plate for additional stabilization to prevent migration of the cage post-surgery. The procedure is concluded with careful wound closure using layered suturing techniques and preparation for postoperative care, highlighting the comprehensive approach taken to facilitate the patient’s recovery.

Specialties