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General Orthopaedics

A NOVEL TECHNIQUE FOR DETERMINING TRANSVERSE SKIN INCISION SITE FOR ANTERIOR CERVICAL SPINE SURGERY

12th Combined Meeting of the Orthopaedic Associations (AAOS, AOA, AOA, BOA, COA, NZOA, SAOA)



Abstract

Background

The transverse skin incision for anterior cervical spine surgery is not extensile, thus it must be made at the accurate level. The use of palpable bony landmarks is unreliable due to anatomical variations and pre-operative fluoroscopy to identify the level takes up operating room time, increases the radiation dose to the patient and increases the overall cost of the operation.

Objective

To describe a simple, fast and inexpensive method of accurate transverse skin incision placement for anterior cervical spine surgery and to report on its use in 54 consecutive adult patients.

Patients and Methods

In each case a ratio was recorded on the lateral cervical spine radiograph based on the distance between the clavicle and mandible and the operative level; this was then applied to measurements on the patient's neck.

Results

Procedures performed consisted of a mix of discectomy and fusion, disc replacement and combinations of both. The operative level ranged from C2-C3 to C7-T1, the most common being C5-C6. Twenty-three patients had a single-level, 26 a two level and 5 a three level procedure; all cases were performed through one single transverse incision.

Conclusion

We describe the highly successful use of a straightforward method for accurate level transverse skin incision placement for cervical spine surgery In no case was it necessary to radically extend or to make a separate incision. There were no cases where the wrong level was operated on.


C Kennedy, University College Hospital Galway, 66 Garrai de Bruan, 091 Galway City, Ireland