DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Cervical spondylosis C5-C6, C6-C7.
POSTOPERATIVE DIAGNOSIS:
Cervical spondylosis C5-C6, C6-C7.
OPERATION PERFORMED:
1. Anterior cervical decompression fusion, partial corpectomy C5-C6.
2. Discectomy and fusion C6-C7.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: Endotracheal.
INDICATIONS FOR OPERATION: This is a (XX)-year-old female who was seen in the office because of pain in her neck and left upper extremity with radicular pain and numbness over the C6-C7 dermatome. X-ray and MRI showed cervical spondylosis C5-C6, C6-C7. The patient was explained treatment options and elected to proceed with the surgical option. The procedure and possible complications including death, neurological damage, infection and continued symptoms were explained to the patient. She understands and gave consent.
DESCRIPTION OF OPERATION: SSEP monitoring was done. With the patient in the supine position, both arm slight traction was applied to allow for extra exposure. Preps and drapes were done in the usual fashion. An approach from the right side was made, about 2.5 fingerbreadths above the right clavicle. The first 2-inch incision was made. The incision was carried down to the subcutaneous tissue, down through the platysma. The space between the strap muscle and sternocleidomastoid muscle were developed. The deep vertebral fascia was opened with the carotid sheath retracted laterally. Needle was introduced at C5-C6 and x-ray was obtained to verify positioning. The veins underneath the colli muscle were coagulated and self-retaining retractor was placed.
We started with the C6-C7 interspace. The incision was made into the annulus and discectomy was carried out. Two distraction pins were applied, one at C7 vertebra, one in C6 vertebra. Distraction was applied. Further total discectomy was carried out removing the cartilaginous plane and exploring the bony endplate. Under microscope control, the bur was used to remove the posterior osteophyte and from the posterior edge of the vertebrae. The ligamentum flavum was exposed and the spinal cord was decompressed from along its entire width. A hook was used to probe the foramina, both right and left. Distraction was removed and pins were applied in the C5 vertebra. Distraction was carried out. Incision was made in the annulus. Again under microscopic control, a total discectomy was carried out exposing the bony endplate. Midas Rex was used and we did a partial corpectomy, removing about 2 to 3 mm from both vertebrae posteriorly, superiorly and inferiorly from posterior border of the vertebra.
The spinal cord was exposed quite nicely from one end to another. Both foramina were quite open, the bandage scissors were used to remove the osteophyte. Again, a hook was used to verify the foramina bilaterally. Irrigation was carried out. We started at C6-C7, we sized 5 for the cage. Rasps were used to repair both endplates. A 5 cage was introduced into the C6 vertebra after distraction was applied. Then, distraction was removed after the cage was countersunk. A BMP sponge was left in the cage. Again, the same distraction was removed and the same size was used between the 5 and 6 vertebrae. Again, the cage between 5 and 6 was countersunk along with BMP sponge in the cage.
Pins were removed. The osteophytes were removed anteriorly. Appropriate endplate was bent to accommodate the anterior aspect of the spine and then 6 screws were applied and the screws were 3.5 mm in diameter, 20 mm in length, self-tap, applied in each vertebra. The locking mechanism was secured in place. Position was good in the PA and lateral views on the C-arm. Irrigation was carried out. Suction Hemovac was left in place. The wound was closed loosely in layer using 0 Vicryl suture followed by 3-0 Vicryl in the platysma and subcuticular closure with adhesive skin. Pressure dressing was applied. The patient tolerated the procedure well and was sent back to recovery in satisfactory condition.
