San Antonio-based orthopedic spinal surgeon Antonio Webb, MD, brings us into the operating room (OR) for an artificial disc replacement procedure.
Following is a transcript of the video (note that errors are possible):
Webb: All right, a left incision there. All right, let me have kittners, please. [...] Pull towards you a little bit. All right, a little bit deeper there. [...] Right there.
What's up, guys? Dr. Antonio Webb here. I'm an orthopedic spine surgeon here in San Antonio, Texas. Today, we are doing a cervical artificial disc replacement. This is a procedure that is done to replace the cushions in the neck with artificial ones. This is usually done to relieve the pressure that's on the spinal cord and nerves that could be causing pain and radiating pain down the patient's arm. This is a really delicate procedure. The stakes are really high and we're hoping for a successful outcome for this patient today. And yep, looking forward to it. It should be a great case.
I just want to... Stay right there, Ellen. I just want to confirm in the disc there. I didn't want to stick it until we confirmed there. Stay right there. OK. 3, 4, 5, 6, 7. OK, go north, please. Actually, can you [magnify] that for me? Stop here.
We can also look at it and take a look. Let's see where the midline is. I think it's a little bit toward me. That's what it looks like when I look in here. All right, may I have the Bovie, please? OK. It is there. Pull towards you. Can I have an ... here?
Good. There you go. All right, let's get that retractor again. All right, let's get a Caspar [...], please. It just looked larger for some reason. Thank you. OK. [...] Can I have a 3 Kerrison, please?
This is the disc that we're removing here. This patient has a severely tight spinal cord and foraminal stenosis, which means that his nerve root is really tight. He presented to my office with really severe neck and arm pain. We're cleaning out the disc now, removing the disc, performing the discectomy portion.
We have our Caspar pins in. These are the pins that are in the vertebral body and I opened up the disc space. A 3 Kerrison? Then I am working all the way back towards the spinal cord and we're going to decompress his spinal cord and nerves at this level. We're at the C6, C7 level at this point. We'll be able to run a motor like in 10 minutes.
Right now, I'm just removing this bone here. It's at the posterior aspect of his vertebral body, kind of at the end plates posteriorly. What this does is it gives me a great view of his spinal cord, which is right under there. That's where he has all the compression at. I'm just working my way across. What I'm doing now is just moving all of the posterior aspect of the vertebral body that's compressing it. I'm working right on top of his spinal cord here.
This is the arthroplasty device here. It has a center kind of core and it has these little spikes into the implant, and that will grow into the bone over the next few weeks. It feels like it's a pretty good fit too. Yeah. I think I'm OK with that placement there.
Surgical Assistant: I like that.
Webb: Yeah. OK. All right, so let's get a Caspar pin. [...].
Now we're going to the C5, C6 level. This is the level where he has the tightest compression. His nerves are severely tight. He has a C6 radiculopathy, which means he has a pain that's radiating down the arm. Bovie, please. A C6 distribution. This is the level where I need to pay attention to that left side where most of his complaints are.
This is the spinal cord right here. This bluish structure is the PLL [posterior longitudinal ligament]. I have my hook of my Kerrison right under the lip of the PLL. I'm just biting it, removing that ligament so I can effectively decompress the spinal cord. All right, nerve hook.
His MRI showed that he had pretty severe nerve compression on this left side over here, which he does. I'm just making more space for that nerve right now. Nerve hook, please. Right now I'm just checking to make sure my decompression is thorough and adequate.
This is a steroid medication right here. I'm just putting it right on top of his trachea and esophagus. Pick up, please. This little... it's called a gel foam. It's like a little spongy substance here. It has some steroids on it. It's also a medication called thrombin to help with the bleeding postoperatively.
OK. We're replacing a little drainage catheter in the patient's neck. If any fluid decides to accumulate, this will collect it and put it into a little reservoir so it's not staying inside of his neck. We'll pull this before he leaves the hospital tomorrow. We did the whole surgery through, it's like a 3.5 cm incision, almost 4... 4 or so, a 4 cm incision. We'll get him off to the recovery room. Thank you. Thank you. I appreciate it.
This is the lateral view, looking at it from the side here. This is C2, 3, 4, 5, 6, 7. We replaced the cushions and took the pressure off his spinal cord at these two levels here. This is what it looks like from the A to P [anterior to posterior], the disc replacement kind of right down the center here. Postoperatively, we'll get him up and start walking later this afternoon.
Most patients that have this surgery they're in the hospital for probably less than 23 hours. It's 3:30 in the afternoon. He'll go home tomorrow morning and off to recovery. But recovery for this is about 4 to 6 weeks, so a quicker recovery than a fusion. As I was mentioning, there are a lot of different advantages to a disc replacement over a fusion. That's maintenance of your motion and quicker recovery. It decreases the chance that you'll need further surgery in the future. Most importantly, we help him with his neck and arm pain.
Antonio Webb, MD, is a spine surgeon located in San Antonio. You can learn more on his website or YouTube channel.