A Anterior cervical diskectomy or fusion
Anterior cervical diskectomy or fusion is most commonly performed for symptomatic nerve root or cord compression. Compression may occur from protrusion of an intervertebral disk or osteophytic bone into the spinal canal. An intervertebral disk usually herniates at the fifth or sixth cervical levels. A bone graft may be taken from the iliac crest or backbone may be used.
2. Preoperative assessment and patient preparation
a) Airway assessment should include thorough assessment of the range of motion of the neck. Neurologic deficits with limited neck movement may require intubation with the head in a neutral position. Intubation can be performed using passive immobilization or in-line traction with assistance of the GlideScope. Awake fiberoptic intubation with proper positioning is the safest option. Avoid flexion, extension, and lateral rotation of the head.
b) Neurologic deficits should be documented. Patients typically complain of neck pain radiating down one arm, which can progress to weakness and atrophy.
c) Diagnostic tests include type and screen, complete blood count, and other tests as the patient’s condition indicates.
d) Preoperative medication and intravenous (IV) therapy: Patients may have considerable pain preoperatively and require a narcotic with premedication. If a difficult airway is anticipated, premedication should be used sparingly. Use a 16- or 18-gauge IV catheter with minimal fluid replacement.
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