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Anterior cervical microdiscectomy (intraoperative photograph)

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This panel is a sequence of surgical steps oriented with the patient’s head to the left, and feet to the right, as the surgeon views the field. The upper left photograph illustrates the C5-6 interspace after the disc and calcified posterior longitudinal ligament have been removed, exposing the dura covering the spinal cord. The nerve hook indicates an epidural vein over the left C6 root sleeve. The upper right photograph illustrates passage of the nerve hook out the left C6 foramen, confirming thorough decompression of the root after removal of disc fragments. Allograft tricortical iliac crest bone grafts are in position at each of the interspaces, C5-6 and C6-7, in the lower left photograph. In the lower right photograph, the titanium plate spanning C5-7 is held by a pair of screws in each vertebral body, allowing earlier mobilization of the patient while maintaining satisfactory alignment with retained disc height. (Contributed by Dr. Saul Schwarz.)