2018 HONORABLE MENTION

Cervical disk herniation can produce a focal compression of the spinal cord, giving rise to an ischemic lesion that leads to myelopathy. In addition, it can compress a nerve root, causing brachialgia and upper limb deficits. Cervical radiculopathy and myelopathy are common in adults and their consequences can be very serious, resulting in spastic quadriplegia or nerve root paralysis. Anterior cervical diskectomy and fusion is one of the most commonly performed procedures for the management of radiculopathy and/or myelopathy, usually resulting in good clinical outcomes. It is mainly performed if radiculopathy and/or myelopathy are the result of an anterior compression or if one or two disk levels are involved.

This video demonstrates the surgical technique for anterior cervical diskectomy and fusion in a 45-year-old man who has a C5-C6 disk herniation with myeloradiculopathy, brachialgia, pectoral fasciculation, and inferior limb weakness associated with ambulation impairment.

The surgical steps discussed in the video include the anterolateral approach to the mid-cervical spine, diskectomy and decompression according to Smith and Robinson, interbody fusion with the use of autologous bone graft harvested from the iliac crest, and stabilization with the use of a plate and screws. Graphic illustrations are included to support the video and better explain the technique.

Anterior cervical diskectomy and fusion is a reliable procedure, leading to substantial clinical and electrophysiologic improvement. This video may help surgeons at any stage of their career understand how to approach and manage cervical myeloradiculopathy appropriately. Potential pitfalls associated with this technique are reviewed and discussed.