Abstract
Mono- or bisegmental atraumatic microsurgical approach to the anterior cervical spine between C3 and C7 for total disc replacement. 'Soft' disc herniations C3-C7 with radicular symptoms. Ossified 'hard' disc herniations with preserved segmental motion. Erosive osteochondrosis with signs of activation (MRI: Modic I changes) and neck pain. Relative Indication: Adjacent segment degeneration following fusion. Thyromegalie. Multiple previous cervical operations. Other implant-specific contraindications: Anterior osteophytes. Range of Motion (ROM) less than 5° (flexion/extension). Segmental collapse. Endplate anomalies (e.g. excessive concavity of cranial endplate). Endplate defects (e.g. Schmorl's nodes). Cervical myelopathy (limited postop evaluation of the spinal canal and spinal cord if implant is made out of ferromagentic materials). Through a 2.5-3 cm skin incision, exposure and splitting of the platysma muscle. Blunt dissection between carotis sheath and esophageus/trachea with preservation of the thyroid blood vessels and the strap muscles (especially m. omohyoideus) and the recurrent laryngeal nerve. Exposure of the anterior disc space between the longus colli muscles after splitting of the prevertebral fascia. Mobilisation the same day after 6-8 hrs. Functional postop treatment. Implant-dependent postop soft collar for max. 14 days. Safe and reliable anterior approach with low peri- and postoperative morbidity. In large series (> 900,000 operations) complication rate range between 2-2.9% [20]. Approach related complications are rare: postop Hematoma 0.39%, vascular Injuries (carotid artery, vertebral artery) (0.06%). Vocal cord palsy 0.14%, dysphagia 0.75%. Older age and cervical myelopathy have been identified as significant risk factors. Both situations don't play a significant role in total disc replacement since this type of operation is usually performed in young patients. Moreover, cervical myelopathy is still considered as a relative contraindication for total disc replacement.
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