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(Continued from page 40)
was anatomically located and injected with xylocaine .5% with epinephrine 1:200,000. The skin was prepped and draped. The skin was incised with a scalpel and undermined. The platysma incised in the longitudinal direction and undermined. A plane was developed just lateral to the trachea/esophagus and medial to the carotid neurovascular bundle. This was carried down to the anterior prevertebral fascia which was opened either bluntly or sharply. Using a condom protected right angle bent monopolar, the longus colli bilaterally were dissected and held in place with self-retaining retractors. A spinal needle protected with a hemostat was placed into the disc space to fluoroscopically confirm the level. The disc space was marked with a skin marker and the spinal needle removed. The disc was incised with a scalpel and disc material removed. Next Casper posts which had been previously waxed were screwed into the vertebral body above and below the intended disc space. The vertebral bodies were then distracted. The endotracheal cuff was deflated and inflated to "just enough" pressure. This minimizes the risk of postoperative hoarseness. The remaining of the disc material was removed. Osteophytes were removed. The foramen is opened. The posterior longitudinal ligament removed. The end plates curetted or removed with the high speed drill. Then using an angled curette, holes were poked into the vertebral bodies. The disc space was measured. Several pieces of gel foam were put into the disc space. The fibular strut which had previously been soaking in normal saline was cut to the appropriate size. The bone graft is then taken to the disc space to make sure of a proper fit. The bone is then taken out of the disc space. The fibular strut graft was then placed vertically on to one blood soaked piece of gel foam on a Petri dish and then 200 micron core coralline hydroxyapatite granules poured into the center of the fibular strut. Additional blood soaked gel foam is wrung out on to the chips, the chips slightly compressed until they completely fill the shaft of the fibular strut. After the fibular strut is filled with coral chips, the pieces of gel foam are removed. Any stray pieces of coral chip are aspirated off the sides of the fibular strut prior to it being placed into the disc space and gently tapped into place. The vertebral body distraction is removed and fluoroscopic x-ray confirms the 2 to 3 mm. counter-sunk bone graft with coral chips. Next, utilizing a nerve hook the graft is attempted to be removed and neck flexion is performed by the anesthesiologist. The Casper posts are removed and the holes filled with additional bone wax. The wound is copiously irrigated with Bacitracin solution. Excellent hemostasis is obtained. The platysma is closed and the wound closed in multiple layers with subcutaneous stitches. The wound is prepped and dressed. A Philadelphia cervical collar is fitted prior to allowing the patient to wake up. Outpatients are checked in the recovery room. They (Continued on page 42)
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