Anterior cervical discectomy and fusion is best performed using microsurgical techniques. The advantage of microsurgical techniques include reduction of tissue trauma, decrease in operative recovery, a reduction of post surgical scarring, and greater precision with reduced risk of neurological injury.

The basic one or two level anterior cervical discectomy and fusion is performed as follows. A 1 to 2 inch incision is made, in a skin crease, between the midline and the sternocleidomastoid muscle. Meticulous dissection is then carried out through several layers of tissue. The surgical plane is created between the carotid sheath laterally and the esophagus and trachea medially. Following exposure of the spine, an x-ray is taken to verify the appropriate level. The periosteum and muscle on either side of the midline is elevated from the bone and retracted. The disc material is removed to the posterior longitudinal ligaments. Cartilage along the bone end plates is removed with curettes. Resection of the posterior ligaments may be performed if there is suspicions that disc material has entered the spinal canal. The posterior margins of the vertebra may be resected to a variable degree to remove bone spurs.

Bone graft is selected and contoured to fit precisely within the disc space. The graft may be obtained from a cadaver, allograft, or may be taken from the patient’s pelvis, autograft. With the disc space fully distracted, the graft is gently impacted into position. The presence of the bone great reconstitutes the normal disc height and enlarges the height of the foramen.

The procedure may be repeated at one or more levels as indicated through the same incision and exposure.

Following removal of disc material and placement of a graft at each level instrumentation may be performed. This generally consists of placing a metallic plate, commonly titanium, over the surface of the vertebra to be fused. The use of instrumentation is generally considered in several situations: multiple fusion levels, cervical instability, placement of a strut graft. The plate is closely contoured to the bony surface and secured by placing two screws into each vertebra.

Following irrigation of the wound, the exposure is closed in several layers; the platysma, the subcutaneous fat, and skin. A small drain may be placed within the depth of the exposure to allow removal of blood post-operatively which may result in pressure upon the patients airway, or spinal cord.