Neurosurgery Outlines. Paul E. Kaloostian

      1.1 Trauma

      1.1.1 Anterior Cervical Fusion/Posterior Cervical Fusion

      Indications

      • Traumatic occipitoatlantal disjointment

      • No complete arch of C1

      • Bursting C1 fracture (see ▶Fig. 1.1)

      • Congenital abnormalities

      • Odontoid movement into foramen magnum

      • Vertebral shifts

      Symptoms and Signs

      • Stiff neck

      • Sharp pinpoint pain in neck

      • Soreness lasting >7 days

      • Weakness in neck muscle

      • Tingling/Numbness in general neck area

      • Trouble gripping objects

      • Tingling in finger tips

      • Frequent tension headaches (~4+ days per week)

      Surgical Pathology

      • Traumatic brain injury (TBI)

      • Traumatic injury to general neck region

      – Fracture/Displacement/Compression

      Surgical Procedure

      1. Informed consent signed, preoperative labs normal, no Aspirin/Plavix/Coumadin/other anticoagulants for at least 12 days

      2. Appropriate intubation and sedation

      3. Horizontal skin incision 1 to 2 inches on either side of the spine

      4. Split thin muscle underlying skin

      Fig. 1.1 (a–c) A man suffered an incomplete cord injury after a vehicle crash. Radiology revealed that his cervical trauma was a C5 complete burst fracture. (Source: Diagnostic Features. In: Vialle L, ed. AOSpine Masters Series, Volume 5: Cervical Spine Trauma. 1st ed. Thieme; 2015).

      5. Enter plane between sternocleidomastoid muscle and strap muscle

      6. (Anterior) Enter into the plane between trachea/esophagus and carotid sheath

      7. Dissect away thin fascia

      8. Locate disk (preoperative imaging match/intraoperative fluoroscopy)

      9. Remove disk by cutting annulus fibrosis and nucleus pulposus

      10. Remove entire disk including cartilage endplates to reveal