Abstract
BackgroundHerniation of the cervical disk material results in interruption of the posterior longitudinal ligament (PLL) in the majority of patients. Routine opening of the PLL during ACDF is a necessary step for complete removal of all disk fragments.ObjectivesSafety measures during PLL opening during microscopic anterior cervical discectomy and risk-free surgeryStudy designA retrospective clinical case seriesPatients and methodsThe study was conducted on 145 patients. The main symptom was radicular pain. Pre-operative identification of PLL was assessed by MRI. All patients were operated upon by ACDF. We started dissection off the midline in patients with intact ligament while we used the site of disruption to start and complete dissection in patients with interrupted ligament. Follow-up was done monthly.ResultsNinety-seven percent of patients underwent single level surgery. The most commonly operated level was C5-6. PLL was interrupted in 60.7% of patients. There was a statistically significant difference between median VAS in immediate, early, and late post-operative period. Bleeding was encountered in 46% of patients. Saline irrigation was a suitable method for hemostasis.ConclusionConventional MRI is the modality of choice for pre-operative identification of PLL. It is better to use the site of ligament interruption to start sharp dissection and to start lateral to the midline in intact ligament. Sharp dissection is better with curved knife. Thin foot plate Kerrison is suitable for excision of the remaining parts. Hemostasis using saline irrigation is better and non-risky than using bipolar coagulation.
Highlights
Cervical disk herniation results from a tear in the posterior annulus and the posterior longitudinal ligament (PLL)
Conventional Magnetic resonance imaging (MRI) is the modality of choice for pre-operative identification of PLL
During microscopic anterior cervical discectomy with fusion (ACDF), violation of the PLL aiming at dural exposure and subligamentous disk fragment removal is
Summary
Cervical disk herniation results from a tear in the posterior annulus and the posterior longitudinal ligament (PLL). There is a sequestrated disk fragment inside the spinal canal causing cord and/or root compression [1]. During microscopic anterior cervical discectomy with fusion (ACDF), violation of the PLL aiming at dural exposure and subligamentous disk fragment removal is. The extradural veins are anastomosed beneath the PLL. The contribution with the internal veins forms a confluence at the intervertebral foramen. The nerve roots, as they leave the intervertebral foramen, have. Herniation of the cervical disk material results in interruption of the posterior longitudinal ligament (PLL) in the majority of patients. Routine opening of the PLL during ACDF is a necessary step for complete removal of all disk fragments
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