Introduction
Surgical decompression is the main objective for many spinal procedures. Decompression may be performed in the cervical, thoracic, lumbar, or sacral spine, from a single approach or a combination of anterior, lateral, or posterior approaches. Traditionally, an open surgical technique has been utilized, however, minimally invasive spine (MIS) surgery techniques have gained traction due to improved perioperative morbidity, faster return to work, decreased cost, decreased opioid use, and decreased length of hospital stay. In this chapter, surgical instruments used in decompressive procedures of the spine will be introduced.
Cervical approaches
Anterior approach via anterior cervical discectomy and fusion (ACDF) or arthroplasty
A scalpel is used for the skin incision (No. 10 or 15 blade) ( Fig. 2.1 ) and subplatysmal dissection is performed with Metzenbaum scissors and nontoothed forceps. Medial structures (trachea and esophagus) are retracted using Cloward retractors, and blunt dissection exposes the prevertebral fascia. Dissection of the longus colli muscles is accomplished with electrocautery ( Fig. 2.2 ). Annulotomy is typically performed with a No. 15- or 11-blade scalpel followed by removal of disc fragment with pituitary rongeurs ( Fig. 2.3 ), curettes, and Kerrison rongeurs ( Fig. 2.4 ). Several different sized cutting and diamond high-speed drill burrs may be used to remove disc fragments and cartilage from the end plates. Ventral decompression of the posterior longitudinal ligament (PLL) may be achieved by establishing a plane from the spinal canal dura with a combination of a nerve hook ( Fig. 2.5 ), curettes, and Kerrison rongeurs.
