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Anterior cervical fusion: Some new tools
Surg Neurol 1984;21:323-4
323
Anterior Cervical Fusion: Some N e w Tools D. M. Boles, B.Sc., MB Bch. (Rand), F.R.C.S. (Glasgow), and R. G. Klomfass Garden City Clinic and Department of Anatomy, University of Witwatersrand Medical School, Johannesburg, South Africa
Boles DM, Klomfass RG. Anterior cervical fusion: Some new tools. Surg Neurol 1984;21:323-4.
Some new instruments for anterior cervical fusion of the spine are described. They are believed to be superior to those currently available. KEY WORDS: Cervical fusion; New instruments.
It has often been said that an instrument in surgery is only as good as the surgeon behind it: on the other hand, however, it is believed that a surgeon is sometimes as good as his instruments, especially in an area necessitating delicate protection o f surrounding structures. The anterior cervical approach to the spinal cord is not the least of these areas, and some instruments made by the authors are presented. T h e y are believed to be superior to those available at the present time.
approach. Once the retractor is positioned, it can easily be controlled by delicate pressure from the assistant; the disk can then be removed using a single pituitary rongeur aided by the curettes (Figures 1-6).
Discussion In the approach to the anterior cervical spine, the structures mentioned previously are drawn to either side; it is believed that the most important function of the retractor in this area is to hold them out of the way without penetrating or bruising them unnecessarily. The instrument can be inserted and has blades of various sizes that can be interchanged easily; moreover, once inserted, it remains in position without any maneuvering. Visualization of the anterior surface of the spinal col-
Materials and M e t h o d s Most anterior cervical fusions are p e r f o r m e d through a right anterior approach with a horizontal incision and separation o f the platysma muscle, dividing the natural dissection plane between the sternocleidomastoid muscle and the midline structures. T h e carotid artery and internal jugular vein, together with the vagus nerves and sympathetic chain, are structures that must be treated with extreme care, as well as those such as the trachea and especially the esophagus [I,2]. Instruments currently available are believed to be inadequate for this purpose; thus, a small retractor is presented that has been used by the authors for this
Address reprint requests to: Mr. David M. Boles, Garden City Clinic, P.O. Box 96436, Brixton, Johannesburg, South Africa. 6) 1984 by Elsevier Science PublishingCo., Inc.
Figure 1. The detachable handle CaJ with the blades (bJ of the retractor facing upward. The blades, which can easily be exchanged for different sizes, clip open at the required u.idth.
0090-3019/84/$5.00
324
Surg Neurol 1984;21:323-4
Boles and Klomfass
Figure 2. The three scrapers (a, b, and c) used for removing the disk material.
Figure 3. An enlargement of the cutting end of scraper a, shown in Figure 2.
Figure 6. The retractor (a) in position, with the anterior surface of the cervical vertebral column visible in the depths (b). The Cloward spreader (c) is in place on the left.
Figure 4. An enlargement of the cutting end of scraper b, shown in Figure 2. This scraper is used for the very narrow spaces between higher-level disk (for example, C2-3).
umn is good and can be as wide as three levels; indeed, this instrument is specifically designed for use with the operating microscope. The curettes are on long handles, enabling accurate and easy control, and they have sharp cutting surfaces, that will peel the cartilaginous part of the annulus (or end plate) from the bone, leaving a raw bone surface ideal for fusion when the small portion of bone taken from the iliac crest is inserted into the emptied disk space. It is hoped that these instruments will aid the surgeon who works regularly in this area; as a patent is pending, they can be purchased from the authors (from R.G.K. through D.M.B.).
References
Figure 5. The retractor in position, with the patient's head to the left.
1. Cloward RB. The anterior approach for removal of ruptured cervical discs. J Neurosurg 1952;15:602-14. 2. Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc removal and interbody fusion for cervical disc syndrome. Johns Hopkins Hosp Bull 1955;96:233-4.
323
Anterior Cervical Fusion: Some N e w Tools D. M. Boles, B.Sc., MB Bch. (Rand), F.R.C.S. (Glasgow), and R. G. Klomfass Garden City Clinic and Department of Anatomy, University of Witwatersrand Medical School, Johannesburg, South Africa
Boles DM, Klomfass RG. Anterior cervical fusion: Some new tools. Surg Neurol 1984;21:323-4.
Some new instruments for anterior cervical fusion of the spine are described. They are believed to be superior to those currently available. KEY WORDS: Cervical fusion; New instruments.
It has often been said that an instrument in surgery is only as good as the surgeon behind it: on the other hand, however, it is believed that a surgeon is sometimes as good as his instruments, especially in an area necessitating delicate protection o f surrounding structures. The anterior cervical approach to the spinal cord is not the least of these areas, and some instruments made by the authors are presented. T h e y are believed to be superior to those available at the present time.
approach. Once the retractor is positioned, it can easily be controlled by delicate pressure from the assistant; the disk can then be removed using a single pituitary rongeur aided by the curettes (Figures 1-6).
Discussion In the approach to the anterior cervical spine, the structures mentioned previously are drawn to either side; it is believed that the most important function of the retractor in this area is to hold them out of the way without penetrating or bruising them unnecessarily. The instrument can be inserted and has blades of various sizes that can be interchanged easily; moreover, once inserted, it remains in position without any maneuvering. Visualization of the anterior surface of the spinal col-
Materials and M e t h o d s Most anterior cervical fusions are p e r f o r m e d through a right anterior approach with a horizontal incision and separation o f the platysma muscle, dividing the natural dissection plane between the sternocleidomastoid muscle and the midline structures. T h e carotid artery and internal jugular vein, together with the vagus nerves and sympathetic chain, are structures that must be treated with extreme care, as well as those such as the trachea and especially the esophagus [I,2]. Instruments currently available are believed to be inadequate for this purpose; thus, a small retractor is presented that has been used by the authors for this
Address reprint requests to: Mr. David M. Boles, Garden City Clinic, P.O. Box 96436, Brixton, Johannesburg, South Africa. 6) 1984 by Elsevier Science PublishingCo., Inc.
Figure 1. The detachable handle CaJ with the blades (bJ of the retractor facing upward. The blades, which can easily be exchanged for different sizes, clip open at the required u.idth.
0090-3019/84/$5.00
324
Surg Neurol 1984;21:323-4
Boles and Klomfass
Figure 2. The three scrapers (a, b, and c) used for removing the disk material.
Figure 3. An enlargement of the cutting end of scraper a, shown in Figure 2.
Figure 6. The retractor (a) in position, with the anterior surface of the cervical vertebral column visible in the depths (b). The Cloward spreader (c) is in place on the left.
Figure 4. An enlargement of the cutting end of scraper b, shown in Figure 2. This scraper is used for the very narrow spaces between higher-level disk (for example, C2-3).
umn is good and can be as wide as three levels; indeed, this instrument is specifically designed for use with the operating microscope. The curettes are on long handles, enabling accurate and easy control, and they have sharp cutting surfaces, that will peel the cartilaginous part of the annulus (or end plate) from the bone, leaving a raw bone surface ideal for fusion when the small portion of bone taken from the iliac crest is inserted into the emptied disk space. It is hoped that these instruments will aid the surgeon who works regularly in this area; as a patent is pending, they can be purchased from the authors (from R.G.K. through D.M.B.).
References
Figure 5. The retractor in position, with the patient's head to the left.
1. Cloward RB. The anterior approach for removal of ruptured cervical discs. J Neurosurg 1952;15:602-14. 2. Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc removal and interbody fusion for cervical disc syndrome. Johns Hopkins Hosp Bull 1955;96:233-4.