Anterior Cervical Decompression

The anterior cervical approach was developed to provide a minimally invasive alternative to ACDF to address herniated cervical discs causing radicular pain in the arm and shoulder. The anterior approach is used when the herniation lies anterior to, and between the lateral borders of, the spinal cord. To use this approach, the disc must have a height of at least 4 mm and fragment sequestration must be limited to half the height of the vertebral body.

The unique design of the anterior cervical system includes an oval working sleeve with interlocking high definition rod lens endoscope. The narrow height of the oval working sleeve allows it to fit in the cervical disc space, while the larger width of sleeve allows side-by-side passage of the endoscope and manual instruments. The working sleeve passes into the disc space and provides the surgeon with access to the posterior portion of the disc and the epidural space. Resection of bone with burrs or a bone punch may be necessary to access the site of the herniation.

Technique Summary:

  • The approach starts anteriorly and contralateral to the pathology
  • With careful palpation, the anterior disc is identified in the interval between the sternocleidomastoid/carotid and the esophagus/trachea
  • A guide rod is inserted into the disc followed by the dilator and working sleeve
  • The scope is inserted into the working sleeve to visualize the posterior disc
  • Instruments are inserted through the working sleeve to remove the herniation under direct visualization