Fundamental spinal surgical techniques for degenerative cervical spine disorders

Abstract

Surgical treatment of degenerative cervical spine disorders is a common surgery in neurosurgical practice. This article describes the fundamental surgical techniques and operative complications of anterior cervical discec-tomy and fusion, and laminoplasty based on the author's experience. Anterior fusion is best indicated for the anterior pathology such as in cases of disc hernia and spur formation at one or two disc levels. Key anatomical structures encountered in the anterior approach include the sternocleidomastoid, omohyoid, longus colli muscles, common carotid artery and esophagus. For decompression, bony spurs are carefully drilled using a diamond bur under the microscope, and then removed with curettage. Iliac bone grafting is a standard, but the titanium cages have almost the same bony union rate. For the posterior approach, key structures to note are the nuchal ligament, trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis and multifidus muscles. Gutters are made at a point immediately medial to the facet joint to fully decompress the spinal canal. Finally, reconstruction of the posterior soft tissue structures such as the nuchal ligament and the attached muscles is important to decrease postoperative pain. A thorough understanding of the possible complications and postoperative sequela is essential for management of cervical degenerative spine disorders.