Cervical discectomy C6-C7 with arthrodesis

Detailed technique by Dr. Andreas Leidinger

At SurgSchool, the innovative online surgery app, we are committed to providing the highest quality educational content for medical professionals. Today, we highlight a keynote address: C6-C7 cervical discectomy with arthrodesis, performed by the neurosurgeon Dr. Andreas Leidinger, of the prestigious Hospital of Santa Creu i Sant Pau in Barcelona. This case, available in its entirety on our platform, is a perfect example of the precision and technique required in degenerative spine surgery.

Clinical Case Presentation: When Pain Radiates

The patient, a 40-year-old woman, presented with a picture of Right lateral neck pain with persistent radiation down the right arm, following the C6 dermatome (brachialgia). Magnetic resonance imaging (MRI) studies were conclusive: a cervical disc herniation in the C6-C7 spaceThis hernia not only compressed and distorted the dural sac, but also the emerging right C6-C7 nerve root at the foraminal level, explaining the patient's symptoms.

Surgical Planning and Approach: The Anterior Route

To address the pathology, Dr. Leidinger opted for a anterior cervical approach, a standard and effective technique for this location.

• Positioning and Preparation: The patient was placed supine under continuous neuromonitoring. Mild cervical hyperextension and caudal shoulder traction were applied to optimize the surgical field.
• Strategic Incision: A horizontal skin incision was made over the right anterior cervical triangle, the height of which was verified using a fluoroscope. After the cold knife incision, subcutaneous dissection was advanced with an electric scalpel.
• Dissection by Anatomical Planes: The first objective was to identify the platysma muscle, whose fibers were separated vertically following their natural course. The key to the approach lies in finding the avascular plane between the superficial cervical fascia and the pretracheal fasciaThis safe route allows access to the precervical plane where the definitive retractors would be anchored. Blunt dissection and meticulous control of small vascular structures are essential to maintain a bloodless field.

Key Steps of Discectomy and Nerve Decompression

Once the prevertebral plane is reached and with the self-retaining separators in position, protecting the cervical viscera and exposing the C6 and C7 vertebral bodies:

1. Distraction and Disc Exposure: They were implanted Caspar's pines (12 mm) into the C6 and C7 vertebral bodies under fluoroscopic control, ensuring parallelism with the vertebral endplates. A Caspar distractor widened the intervertebral space, facilitating work on the disc. An anteroposterior radiographic examination confirmed the correct position of the pins relative to the midline.
2. Annulotomy and Microdiscectomy: An anterior annulotomy of the C6-C7 disc was performed using a cold knife. Subsequently, using a combination of disc forceps, Kerrison dissectors, and spoons, the disc was removed. meticulous removal of fragments of the fibrous annulus and nucleus pulposusSpecial attention was paid to cleaning the vertebral endplates. The aspirator, in addition to its primary function, served as a useful palpator in this poorly vascularized space.
3. Foraminal Decompression: After the discectomy, the posterior common vertebral ligament was identified and carefully elevated. Beneath it, the dura mater was made visible, and laterally, the foraminal recesses. The posterior common vertebral ligament was located in the right C6-C7 foraminal recess. extruded hernial fragment, responsible for root compression. This fragment was carefully manipulated with dissectors to free it from nerve adhesions and finally extracted with Kerrison or disc forceps. A "sheet" of venous bleeding from the foramen is usually an indirect indicator of adequate decompression, although final palpation is always performed.
4. Hemostasis: Effective hemostasis was achieved using FloSeal, mechanical compression with a microsurgical liner, and yielding Caspar retractor distraction.

Cervical Arthrodesis C6-C7: Restoring Stability with Interbody Implants

The ultimate goal after decompression is to stabilize the segment by means of arthrodesis (fusion):

• Implant Selection and Placement: Test boxes were used to select the appropriate size of the interbody implant (cage)The final implant, filled with bone mineralization matrix, was impacted into the disc space under strict fluoroscopic control.
• Implant Fixation: Dr. Leidinger uses screw-retained cages that are anchored to the cranial and caudal vertebral bodies by metal wings, providing immediate stability.

Meticulous Closure and Postoperative Care

With the implant successfully placed:

• The retractors and Caspar pins were carefully removed, preventing any damage to adjacent structures. The pin holes were covered with bone wax, Surgicel, or FloSeal to minimize trabecular bleeding.
• Final hemostasis was performed in the precervical plane and a Spongostan sheet was placed.
• Closure was performed in layers, approximating the platysma and subcutaneous cellular tissue with absorbable suture.
• According to protocol, a non-vacuum drain was left in place, usually removed after 24 hours.

Successful Results and Valuable Lessons in SurgSchool

The surgery was uneventful. The patient was discharged 24 hours after the procedure, presenting a complete resolution of brachialgia and significant improvement in neck painThere were no postoperative complications, and follow-up radiological images confirmed the correct position of the implant.

This case by Dr. Andreas Leidinger is a testament to surgical excellence and a valuable learning tool. SurgSchool, you can view this C6-C7 cervical discectomy with arthrodesis in its entirety, observing every technical detail, intraoperative decision-making, and the management of anatomical structures.

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