The Clinical Efficacy of Anterior Cervical Discectomy and Fusion Under Three-Dimensional Microscopy

A plethora of studies has substantiated the remarkable clinical efficacy of anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylotic myelopathy.^1,2 This procedure effectively removes the posterior osteophytes and protruding nucleus pulposus, achieving direct decompression of the spinal cord and effectively alleviating compression symptoms. Concurrently, by distracting the intervertebral space, ACDF contributes to the restoration of the physiological curvature of the cervical spine. However, several pressing issues remain to be addressed during the surgical process. The depth of the surgical field and the lighting conditions often limit the clear identification of the spinal cord and surrounding delicate structures, compounded by the limited operating space and potential interference between the primary surgeon and assistants, all of which may increase surgical risks.^3,4 To surmount these challenges, the application of three-dimensional (3D) microscopy in anterior cervical surgery has been proven to be an effective solution. In Video 1, we demonstrate the complete 2-stage ACDF operation under 3D microscopy, where both the primary surgeon and the assistant observe the surgical area through monitors and external screens, ensuring a comfortable posture and good coordination. In our retrospective review, we analyzed 16 ACDF cases aided by 3D microscopy(including both cervical spondylotic myelopathy with disc herniation and cases with spinal instability). Based on the results of the normality test, we use mean (SD) to describe the data. The mean (SD) decompression time was 37.06 (13.30) minutes, with overall surgical duration of 114.56 (18.11) minutes and blood loss of 68.13 (21.36) mL, with no surgically related complications. At the 6-month follow-up, there was a significant improvement in the Japanese Orthopaedic Association score, neck disability index score, visual analog scale score, and C2-7 Cobb angle compared with preoperative values (Japanese Orthopaedic Association from 11.06 [1.00] to 15.38 [1.09], neck disability index from 30.75 [3.49] to 14.81 [2.93], visual analog scale from 5.19 [1.60] to 1.88 [0.96], and C2-7 Cobb angle from 11.97 [4.63] to 15.49 [4.06], respectively; P < 0.05). 3D microscopy-assisted ACDF demonstrated clear advantages in terms of decompression operation time, intraoperative blood loss, exposure and resection of the posterior longitudinal ligament, and complication rate, achieving satisfactory short-term therapeutic outcomes in the treatment of cervical spondylotic myelopathy. Assisted by 3D microscopy, ACDF surgery offers a high-definition visual field that enhances precision, thereby reducing procedural risks and improving clinical outcomes. This technology alleviates the physical strain on surgeons, fosters collaborative teamwork, and facilitates educational exchanges. With a relatively short learning curve, 3D microscopy significantly enhances the safety and efficiency of ACDF procedures.