Name: Anterior Cervical Discectomy and Fusion in the Ovine Model (Video) | JoVE Journal
Uploaded: 2009-10-05T16:30:00.000+00:00
Duration: 6 min 11 s
Description: Learn anterior cervical discectomy and fusion in the ovine model for neurosurgery and orthopedic research. This technique demonstrates spinal decompression and cage insertion for treating cervical radiculopathy.

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5 minutes

The authors thank Dr Anne Gibbon, Dr Christine Mackay and all the staff at Monash Animal Services and Physiology animal house. The authors thank Jeremy Weinstein and the Mcube team for video and animation production.a

<ol>
 <li>The sheep is fasted for 24 hours but allowed water ad libitum</li>
 <li>The sheep is weighed.</li>
 <li>Anaestheisa is induced by intravenous injection of thiopentone (20mg/kg).</li>
 <li>Prophylactic intravenous antibiotics may be given.</li>
 <li>Endotracheal intubation is performed using a sized 7 to 9 cuffed endotracheal tube. </li>
 <li>Anaesthesia is maintainted with isoflurane, 1&#x2013;3%, in 100% oxygen at a flow rate of 2L per minute.</li>
 <li>Observations are made and the level of anaesthesia monitored continuously. </li>
 <li>The surgical tools needed for this operation include: Toothed forceps, non toothed forceps, Metzenbaum scissors, Mayo scissors, needle holders, scalpel handle (long and short), Kerrison rongeurs, pituitary rongeurs, pneumatic surgical drill, drill bits and guards, nerve hooks (blunt and micro hook), elevator (ie, Watson Cheyne), insulated mono polar and bipolar electrosurgical forceps, vertebral body distractor (ie 16mm Caspar pins), distraction pin drill and drill sleeve, 2-0, and 3-0 angled curettes, Size 7 and 10 French sucker and suction tubing, Langenback retractors and self-retaining cervical retractors.</li>
 <li>The neck region is shaved and washed with a betadine detergent solution.</li>
 <li>The animal is then placed in the supine position onto the operating table and the neck gently extended.</li>
 <li>The skin is marked with a needle and an x-ray is taken to confirm the C3/4 level. </li>
 <li>The neck is then prepped using alcoholic chlorhexidine, alcoholic iodine and 70% ethanol in water.</li>
 <li>A fenestrated square drape is used for the surgical site and a large square drape for the overhead table.</li>
 <li>An operating microscope, or Loupe magnification and headlight, are used for the surgical procedure.</li>
 <li>The incision is made using a scalpel at the site previously identified using the x-ray</li>
 <li>Next, dissection through the investing layers is performed using scissors and a plane developed medial to the carotid sheath and lateral to the trachea and oesophagus.</li>
 <li>Haemostasis is maintained through the procedure using diathermy</li>
 <li>Once the vertebral column is located, the midline should be palpated and care should be taken to ensure that retraction is medial to the carotid artery and lateral to trachea and oesophagus.</li>
 <li>A bayoneted needle is then inserted into the disc (this prevents inadvertent advancement which could risk damaging the spinal cord). A square drape is used to cover the surgical site. Before an intraoperative xray is taken to confirm the C3/4 disc level.</li>
 <li>Casper distraction pins are then inserted in C3 and C4 respectively.</li>
 <li>The disc is incised with a 15-scalpel blade.</li>
 <li>The distractor is then inserted and the disc space gently distracted apart.</li>
 <li>A discectomy is then performed using rongeurs and Kerrison rongeurs. A drill and curettes may also be of assistance.</li>
 <li>The endplates are then prepared using the drill and curettes until bleeding bone visualized.</li>
 <li>The posterior longitudinal ligament may be opened at this point, depending on experimental design. A blunt hook and 1mm Kerrison are best used for this procedure.</li>
 <li>The wound is then irrigated with normal saline, prior to insertion of the interbody cage or test material.</li>
 <li>The distraction is relaxed ad the device checked to ensure that it is securely in place.</li>
 <li>The distraction pins are then removed and bone wax may be inserted to achieve haemostasis in the bone holes.</li>
 <li>The longus coli muscle is closed with Vicryl. Layered closure is then performed, preferably with a subcuticular suture to avoid the need for suture removal.</li>
 <li>Xylocaine is infiltrated around the surgical site</li>
 <li>The anaestheitc gas is switched off and, when spontaneous breathing occurs and signs of swallowing are evident, the endotracheal tube is removed.</li>
 <li>The animal is then allowed to recover in a metabolic cage under constant observation.</li>
 <li>It is important that the animal is positioned upright with legs tucked under it, to prevent regurgitation.</li>
 <li>Once the animal is standing (usually within 1 hour) food and water may be reintroduced.</li>
 <li>Close monitored is performed for 24 hours and continued for 1 week.</li>
 <li>Analgesia is maintained with a Fentanyl patch for 3 days following the operation.</li>
</ol>

<ol><li>Angevine, P. D., Arons, R. R., McCormick, P. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((National+and+regional+rates+and+variation+of+cervical+discectomy+with+and+without+anterior+fusion%2C+1990-1999%5BTitle%5D)+AND+%22Spine%22%5BJournal%5D)">National and regional rates and variation of cervical discectomy with and without anterior fusion, 1990-1999.</a> Spine. 28, 931-940 (2003).</li>
<li>Cloward, R. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+anterior+approach+for+removal+of+ruptured+cervical+disks%5BTitle%5D)+AND+%22J+Neurosurg%22%5BJournal%5D)">The anterior approach for removal of ruptured cervical disks.</a> J Neurosurg. 15, 602-617 (1958).</li>
<li>Jacobs, W. C., Anderson, P. G., Limbeek, J., Willems, P. C., Pavlov, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Single+or+double-level+anterior+interbody+fusion+techniques+for+cervical+degenerative+disc+disease%5BTitle%5D)+AND+%22Cochrane+Database+Syst+Rev%22%5BJournal%5D)">Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease.</a> Cochrane Database Syst Rev. , CD004958-CD004958 (2004).</li>
<li>Kandziora, F., Pflugmacher, R., Scholz, M., Schnake, K., Lucke, M., Schröder, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparison+between+sheep+and+human+cervical+spines%3A+an+anatomic%2C+radiographic%2C+bone+mineral+density%2C+and+biomechanical+study%5BTitle%5D)+AND+%22Spine%22%5BJournal%5D)">Comparison between sheep and human cervical spines: an anatomic, radiographic, bone mineral density, and biomechanical study.</a> Spine. 26, 1028-1037 (2001).</li>
<li>Patil, P. G., Turner, D. A., Pietrobon, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((National+trends+in+surgical+procedures+for+degenerative+cervical+spine+disease%3A+1990-2000%5BTitle%5D)+AND+%22Neurosurgery%22%5BJournal%5D)">National trends in surgical procedures for degenerative cervical spine disease: 1990-2000.</a> Neurosurgery. 57, 753-758 (2005).</li>
<li>Smith, G. W., Robinson, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+treatment+of+certain+cervical-spine+disorders+by+anterior+removal+of+the+intervertebral+disc+and+interbody+fusion%5BTitle%5D)+AND+%22J+Bone+Joint+Surg+Am%22%5BJournal%5D)">The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion.</a> J Bone Joint Surg Am. 40-A, 607-624 (1958).</li>
</ol>

There are some sources of variability to consider while planning and performing anterior cervical discectomy and fusion. Therefore, for consistency of the model, the animals should be of the same age and breed. We prefer two year old, crossbred Leicester Merino sheep. If performed correctly, there will be minimal complications such as bleeding, infection, or mortality. Bleeding should be controlled throughout the procedure and haemosatsis checked before closing. Prophylactic antiobiotics are given at induction to minimse...

<table><tbody><tr><td>Marcain</td><td>AstraZeneca</td><td></td><td>0/5% Bupivicaine hydrochloride solution for injection 100mg in 20 mls</td></tr><tr><td>Thiopentone</td><td>Illium</td><td></td><td>Thiopentone sodium (sterile powder for injection) 5g</td></tr><tr><td>Issoranne</td><td>Baxter Internationl Inc.</td><td></td><td>Isoflurane BP 100%</td></tr><tr><td>Chlorehxidine</td><td>Jurox</td><td></td><td>40mg/ml Chlorhexidine glucoronate</td></tr><tr><td>PVD Iodine Solution</td><td>Apex</td><td></td><td>Povidine Iodine 100mg/ml</td></tr></tbody></table>

anterior cervical discectomy and fusion in the ovine model

Anterior Cervical Discectomy and Fusion in the Ovine Model

Anterior cervical discectomy and fusion (ACDF) is the most common surgical operation for cervical radiculopathy and/or myelopathy in patients who have failed conservative treatment1,5. Since the operation was first described by Cloward2 and Smith and Robinson6 in 1958, a variety refinements in technique, graft material and implants have been made3. In particular, there is a need for safe osteoinductive agents that could benefit selected patients. The ovine model has been shown to have anatomical, biomechanical, bone density and radiological properties that are similar to the human counterpart, the most similar level being C3/44. It is therefore an ideal model in which preclinical studies can be performed. In particular this methodology may be useful to researchers interested in evaluating different devices and biologics, including stem cells, for potential application in human spinal surgery.

This video demonstrates the technique of anterior cervical discectomy and fusion in the ovine model.

Anterior cervical discectomy and fusion (ACDF) is the most common surgical operation for cervical radiculopathy and/or myelopathy in patients who have ...

Anterior cervical discectomy infusion is the most common procedure performed around the world for the surgical treatment of cervical radiculopathy or myelopathy. Here we see a disc protrusion compressing the nerve root, which is inflamed. The disc is removed and the nerve root is decompressed.An antibody cage is then inserted into the disc space to facilitate fusion. Welcome to Monash University, Melbourne, Australia. We are from the departments of surgery and Monash immunology and stem cell laboratories.This is Professor Graham Jenkin and Professor Ross Young. And I'm Dr.Tony Slager, and today we are going to describe to you how to perform Anor cervical discectomy infusion in the OV model. This video will outline induction of anesthesia level identification, prep, and drape the surgical procedure, insertion of the interbody device and enclosure.After induction of anesthesia and intubation, the sheep is placed supine on the operating table. The endo fuel tube is then connected to the anesthetic machine and ventilator. An anesthesia is maintained using inhaled volatile gases.The vital signs are continually monitored and recorded with the oximeter probe secured to the ear. The neck region has already been clipped and cleaned using chlorhexidine and iodine. The neck is extended and everything is kept midline.This enables clearer visualization of the surface landmarks, which makes level identification easier. A needle is then inserted under the skin, and an x-ray is taken to mark the C3 four disc space. The x-ray is then developed using a digital processor.An alternative to this is using an image intensifier. You can see on the x-ray screen that the C3 four level is indicated correctly with the needle. The incision is then centered around this point to prep the neck.A combination of solutions are sprayed on the surgical site, including alcoholic chlorhexidine, alcoholic iodine, and 70%ethanol. These solutions should be allowed to dry and evaporate before starting a drape is placed over the surgical site. We prefer fenestrated square drape, which gives good access and exposure.The instruments are positioned on the overhead table and the dither and suction are all clipped into place. We recommend using magnification for this procedure. We use loops and a headlight, however, an operating microscope can be used.If this is available, we prefer to use a longitudinal incision as this facilitates easier access to the vertebral column in the sheep. The incision is then made. Dissection is carried out in a sharp fashion through the investing layers, and then developing a surgical plane medial to the carotid sheath and lateral to the truch and esophagus.Langle and back or right angle tractors are used until the disc base is identified. Care should be taken at this point to double check that the plane is medial to the carotid sheath. The longest coline muscle is elevated using diathermy, and when adequate exposure is achieved, self attaining retractors are inserted.These facilitate easy axis to the disc space without the need for constant manual retraction prior to inci the disc. An intraoperative x-rays taken to confirm that this is in fact the correct level After level confirmation, the Caspar distraction pins are inserted into the C3 vertebral body above and the C four vertebral body below. We use 16 millimeter distraction pins.As the anatomy of the sheep vertebral body is deep and maximal distraction can be achieved safely with a larger size distraction pins prior to distracting the space apart. We recommend in sizing the disc using a 15 scalpel on a long handle. As this relieves the tension and allows for distraction more easily, the discectomy is then carried out using up cutting gers and pituitary gers until a maximal discectomy has been achieved.Once a disc has been removed, the disc space can be easily visualized. The end plates are then prepared using curettes or a high speed drill until bleeding bone is visualized to enable fusion to occur. The antibody devices then inserted.In this case, we use a polyether ether ketone or peak cage, which is packed with bone substitute of tri calcium, phosphate and hydroxy appetite and stem cells. However, this model can be used to test a variety of different cages, plates, and matrices, which would be inserted at this time. This is a picture showing the peak cage in position, slightly counter sunk into the C3 four antibody space by two to three millimeters.Layer closure is then performed of the longest coline muscle, and a sub particular suture is inserted, preferably using an absorbable suture such as Vicryl. The main difference of the human is a concavity in the superior vertebral body, in this case, C3, which contains disc material. This is different to the human where the end plates are more flatly shaped.There is also a midline ridge in the sheep vertebral body above the disc. Other than these subtle differences in anatomy, the sheep's cervical spine is very similar to the human, and this reinforces the choice of this model for research in this area.

anterior-cervical-discectomy-and-fusion-in-the-ovine-model

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JoVE Journal

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Learn anterior cervical discectomy and fusion in the ovine model for neurosurgery and orthopedic research. This technique demonstrates spinal decompression and cage insertion for treating cervical radiculopathy.

Anterior Cervical Discectomy and Fusion in the Ovine Model

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