SAMPLE
UCSF OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS:
diskogenic spondylosis at C6-7.
C7 radiculopathy due to chronic disk herniation and
POSTOPERATIVE DIAGNOSIS:
diskogenic spondylosis at C6-7.
C7 radiculopathy due to chronic disk herniation and
OPERATION:
Anterior cervical diskectomy and bilateral
microsurgical foraminotomies with interbody fusion using tricortical allograft and internal
fixation with an anterior screw plate.
ANESTHESIA:
General endotracheal.
CLINICAL INDICATIONS:
This patient presented with intractable
posttraumatic neck and arm pain, worse on the left side, which had not responded to a
variety of therapeutic interventions. The MRI scan was positive for the above diagnosis.
Surgical decompression was recommended. The indications, alternatives, risks,
possible complications, and limitations of the surgery were explained and the patient
requested we proceed.
PROCEDURE:
The patient was anesthetized and intubated in a
supine position on the operating table, taking care to avoid hyperextension of the neck.
The head was placed in a foam cradle with a bolster behind the neck and shoulders.
The operative area was prepared and draped sterilely in the usual manner.
A transverse incision was opened to the level of the cricoid cartilage. It was deepened
through the subcutaneous and platysma layers. A subplatysmal plane was established.
The anterior cervical fascia was incised and the carotid artery was isolated and retracted
laterally with the sternomastoid muscle while the trachea and esophagus were retracted
medially. The prevertebral fascia was incised in the midline and the longus colli muscles
were detached and elevated. A lateral cervical spine x-ray was taken with a marker in
place to verify the level. The self-retaining retractors were placed and secured.
The large anterior osteophyte at C6-7 was resected with rongeurs and the anterior
longitudinal ligament and anulus were incised. A moderate amount of residual
degenerative fibrocartilage was extracted from the intervertebral space. The power drill
was used to flatten the concavity of the C6 and C7 vertebral bodies. A step was cut in
the posterior edge of C7. Under the operating microscope, which was used for
microdissection, the posterior diskogenic osteophyte was débrided down to a residual
thin shell of calcified posterior longitudinal ligament. This was then detached with the
up-angled microcurette and the epidural space was entered. Residual osteophyte
material was resected at this point and the posterior longitudinal ligament was divided
over a blunt hook using sharp dissection. The flaps of the posterior longitudinal ligament
were then resected with the up-angled microcurette. The blunt hook was used to
palpate the floor of the neural canal and foramina to verify that adequate decompression
had been accomplished. Distraction pins were placed in the C6 and C7 vertebral bodies
under lordotic distraction and a 9-mm bone graft size was selected. This was filled with
locally harvested bone chips and then implanted using the graft holder and the impactor
and mallet. The posterior surface of the bone graft was in good contact with the step cut
in the posterior edge of the C6 vertebral body. The operative area was irrigated.
FloSeal was used for hemostasis in the epidural space. A 22-mm Synthes plate was
then selected and found to be of adequate length radiographically. Four screws were
placed, two in C6 and two in C7, angling rostrally and medially above and caudally and
medially below, for fixation of the plate. These were self-tapping 4 x 14-mm screws
except for the left rostral screw, for which an oversized screw was placed using a
4.5 x 14-mm screw. The locking screws were tightened down and the construct was
found to be satisfactory. A final x-ray was taken, showing acceptable position of the
screws, the plate, and the bone graft, with well-maintained vertebral alignment and
correction of the mild kyphotic deformity using the lordotic bone graft.
The operative area was irrigated with antibiotic solution. Final hemostasis was
completed with a bipolar cautery. The sponge and needle count was correct. There
was no specimen. The estimated blood loss was 100 mL and none was replaced. The
closure was accomplished in layers using 4-0 Dexon to the platysma layer and 4-0
Biosyn to the subcuticular layer, followed by Steri-Strips that were applied to the skin.
The patient was placed in a Philadelphia collar. She was extubated and returned to the
recovery room in satisfactory condition. There was no change in the postoperative
neurological examination.
SPONGE AND NEEDLE COUNT:
Correct.
DRAINS:
None.
COMPLICATIONS:
None.
SPECIMENS:
None.
ASSISTANT SURGEON(S):
rev 3/02/05