Otolaryngology-Assisted Approach for Anterior Cervical Discectomy and Fusion

Abstract

First introduced in 1955, anterior cervical discectomy and fusion (ACDF) surgery has seen minimal changes over the years. Its reproducibility, impressive long-term results, and minimal complication rates have established it as one of the most frequently performed cervical spinal fusion surgeries. Yet, postoperative dysphagia remains a concern with a 60% incidence rate. An otolaryngologist's expertise regarding cervical fascial anatomy can inform the spine surgeon's approach to an ACDF to potentially reduce postoperative dysphagia rates. We describe an illustrative case of a 35-year-old woman who presented with 8/10 neck and arm pain along with numbness in her fourth and fifth digits for the past 6 months despite multiple conservative treatments. Cervical spine magnetic resonance imaging demonstrated a large C6-7 central disc herniation resulting in severe foraminal stenosis and moderate C5-6 disc herniation. A C5-7 ACDF was performed. Successful ACDF can be performed using an otolaryngologist-assisted neck approach. Rather than opening the 3 layers of the deep cervical fascia individually and serially, the fascial layers were reflected medially by opening the carotid sheath, where the fascial layers coalesce, and performing the dissection to the spine in a lateral-to-medial fashion. This approach may help decrease rates of dysphagia.