ACDF- steps

Question 1

Positioning

Answer 1

Put the patient in supine position with two distractions.; a 5-8 lb pulley system, and a jelly roll/towel under neck

Question 2

Identify Correct level

Answer 2

using the c-arm + incision site confirmation, mark with sterile marker

Question 3

Prep/Drape

Answer 3

Tape arms and drape patient

Question 4

Incision

Answer 4

using a 15 blade make a transverse incision (for esthetic purposes in line with neck folds) use a bovie to control the bleeding

Question 5

retraction

Answer 5

use hand held retractors or an army navy blunt disect platysma and sternoclediomastoid to expose C-Spine

Question 6

Fuoro Shot

Answer 6

Identify Correct disc space and insert nedle into disc space to assist

Question 7

Distraction

Answer 7

Insert Casper Distraction Pins medially into the superior and inferior vertebral bodies.

Question 8

Ratcheting Distractor

Answer 8

over pin shafts to spread open disc space slowly

Question 9

Boxed Annulotomy

Answer 9

Use an 11 blade to cut ALL and around annulus creating a window to the disc space

Question 10

Discectomy

Answer 10

remove affected disc material with a pituitary rongeur

Question 11

Endplate prep

Answer 11

curettes to remove cartilage, rasp files down surface, burr used to decorticate (get good bleeding bone, use foam (ex-vivigen) to soak up extra blood

Question 12

Decompress

Answer 12

decompress by removing osteophytes with kerrison rongeur (uncinate process &posterior aspects of endplates) Can you nerve hook to manipulate soft tissue

Question 13

PLL Release

Answer 13

optional if needed*

Question 14

Distraction removal

Answer 14

Remove Ratcheting Distractor and weights from neck before interbody trialing

Question 15

Interbody Trialing

Answer 15

Sequence of trials using inserter, mallet and tamp until you determine appropirate size having correct height and lordosis (confirm with C-arm)

Question 16

Final Implant

Answer 16

remove trial & insert final implant cage/allograft spacer using insert mallet and tamp confirm with c-arm

Question 17

ventral gardening

Answer 17

remove any additional osteophytes to create a flat surface

Question 18

Sizing

Answer 18

Use caliper to size for plate

Question 19

Plate positioning

Answer 19

c-arm visualization also can fix with temporary fixation pins

Question 20

Awl

Answer 20

Break through cortex with awl

Question 21

Pilot holes

Answer 21

Using a drill guide and bit drill pilot holes manually or with power

Question 22

Create Threads

Answer 22

If not self-tapping screw, insert tap onto drill guide to create threads

Question 23

Insert Screws

Answer 23

Use screw inserter to insert screw & engage locking mechanism.

Question 24

final steps

Answer 24

final imaging to determine correct position, irrigate, remove retractors, close