Clinical Study: Use of a modified spatula in the anterior cervical discectomy and fusion to prevent damage to midline structures

Abstract

Background: The use of automatic retractors for an anterior cervical approach with discectomy and fusion is not exempt of soft tissue complications. All of this complications consequent to the uninterrupted mechanical compression that may generate inflammation and lesions to structures such as the trachea and esophagus. The modified spatula provides security and protection under the principle of minimal invasion and manual retraction. Methods and Materials: A protective spatula was designed (8 cm x 2.5 cm) with blunt angulated borders and support in the same arms of vertebral retractors to separate the midline structures. This allows a supra-selective approach to the intervertebral space under microscopic vision and protection to the trachea and esophagus, minimizing the traumatic damage generated by the mechanical compression. Results: This variant has been applied to a consecutive series of cases of one or two levels of anterior cervical approach for discectomy and fusion (ACDF), noticing considerably less complications from the compression of the soft structures in the midline. Conclusions: This modified spatula is an alternative to be applied in ACDF cases, under the principle of minimal invasion and manual retraction, providing greater security to prevent soft tissue injury of the midline structures.