Minimalist approach to anterior cervical diskectomy

Since 1975 I have performed a series of 500 anterior cervical diskectomies in my suburban practice. Simple supine positioning and tension in the anterior cervical region created by a folded sheet under the shoulders and posterior neck allowed intraoperative as well as preoperative confirmation of the correct level. The incision was 4.5 cm in length to the left of the midline, and only a small number of standard Cloward instruments were employed. A fiberoptic head light and 4.5x binocular loupes provided adequate illumination and magnification of the entire intervertebral disk space. Removal of degenerative disk material with pituitary rongeurs yielded 4-6 gm of specimen. Microcurettes aided in exploration of the foraminal areas. Use of a power drill facilitated removal of osteophytic ridging. The overall results compared favorably to those of series reporting the results of spinal fusion: minimal blood loss, little tissue swelling, less need for narcotics, fewer days in the hospital, earlier return to normal activity, no wound infection or diskitis, and low rate of reoperation.