26-10. Anterior Cervical Discectomy and Fusion (ACDF): Cloward Technique

1-What is the correct location for the skin incision in the Cloward technique for ACDF?
a) Over the posterior spinous process
b) At the lateral border of the trapezius muscle
c) Over the cervical disc space at the medial border of the sternocleidomastoid muscle
d) At the base of the skull

c) Over the cervical disc space at the medial border of the sternocleidomastoid muscle

2-Which structures are retracted medially during the anterior cervical approach?
a) Scalene muscles and vertebral artery
b) Carotid artery, trachea, and esophagus
c) Jugular vein and spinal cord
d) Lamina and dura mater

b) Carotid artery, trachea, and esophagus

3-What instrument is used to strip the periosteum from the anterior cervical vertebral bodies?
a) Leksell rongeur
b) Cobb elevator
c) Periosteal elevator
d) Kerrison rongeur

c) Periosteal elevator

4-Why is a lateral C-spine X-ray taken during ACDF?
a) To locate the vertebral artery
b) To assess the alignment of the posterior lamina
c) To confirm the correct disc level
d) To check for bone density

c) To confirm the correct disc level

5-What is the purpose of the second incision made over the iliac crest?
a) To access the vertebral artery
b) To insert a spinal stimulator
c) To harvest a bone graft
d) To decompress the spinal cord

c) To harvest a bone graft

6-What is the function of the Cloward self-retaining retractor in ACDF?
a) To retract the dura
b) To maintain exposure to the disc space
c) To spread the spinous processes
d) To elevate the vertebral artery

b) To maintain exposure to the disc space

7-What instrument is used to incise the disc space during discectomy?
a) #10 blade on #3 handle
b) #11 blade on #4 handle
c) #15 blade on #7 handle
d) #20 blade on #3 handle

c) #15 blade on #7 handle

7-Which instrument is used to remove disc material during ACDF?
a) Kerrison rongeur
b) Leksell rongeur
c) Pituitary rongeur
d) Penfield dissector

c) Pituitary rongeur

8-What is the purpose of placing a vertebral spreader into the disc space?
a) To fracture the vertebrae for decompression
b) To retract the spinal cord
c) To allow removal of lamina
d) To distract the vertebrae and open the space for grafting

d) To distract the vertebrae and open the space for grafting

8-Why is a caliper used after disc removal?
a) To measure dura thickness
b) To estimate spinal cord length
c) To ensure proper distraction between vertebrae
d) To determine graft density

c) To ensure proper distraction between vertebrae

9-How is the depth of the intervertebral space prepared for the bone graft?
a) With a scalpel and Kerrison rongeur
b) Using the cervical drill guide and Cloward drill
c) With an osteotome and curette
d) With a high-speed air drill and chisel

b) Using the cervical drill guide and Cloward drill

10-How is the bone dowel prepared before insertion?
a) Soaked in antibiotic solution only
b) Packed with bone cement
c) Trimmed with air drill and rongeur to size
d) Shaped manually with scissors

c) Trimmed with air drill and rongeur to size

10How is the bone dowel inserted into the disc space?
a) Pushed in with a curette
b) Impacted with a mallet and impactor
c) Screwed into place
d) Glued with fibrin sealant

b) Impacted with a mallet and impactor

11-What happens after the bone graft is secured and verified?
a) The disc is removed again
b) The patient is rolled prone
c) Retractors are removed, and the wound is closed in layers
d) The lamina is resected

c) Retractors are removed, and the wound is closed in layers

11-Why might a lateral cervical X-ray be taken before closure?
a) To view the tracheal deviation
b) To check vascular perfusion
c) To confirm graft placement and alignment
d) To ensure skin closure is symmetric

c) To confirm graft placement and alignment

12-What dressings are typically applied to the iliac crest incision after graft harvesting?
a) Transparent film only
b) Steri-strips and Tegaderm
c) Inner contact layer, 4 × 4s, and ABD pad
d) Gauze wrap only

c) Inner contact layer, 4 × 4s, and ABD pad

What postoperative device is typically placed following an anterior cervical discectomy and fusion (ACDF)?
a) Lumbar support brace
b) Cervical collar
c) Compression stockings
d) Arm sling

b) Cervical collar

Which of the following are potential complications following anterior cervical discectomy and fusion (ACDF)?
a) Pneumothorax and liver failure
b) Wound infection and nerve root damage
c) Bladder perforation and bowel obstruction
d) Glaucoma and cataract formation

b) Wound infection and nerve root damag

With cervical disc extrusion, symptoms may be chronic or acute due to:
a) Gradual bone erosion
b) Muscle hypertrophy
c) Nerve root or spinal cord compression following injury
d) Increased blood flow to the spinal cord

c) Nerve root or spinal cord compression following injury

What is the primary advantage of the anterior approach in cervical disc surgery?
a) Requires removal of the lamina
b) Provides a direct approach to the disc space without removing the lamina
c) Requires a posterior incision
d) Avoids the use of bone grafts

b) Provides a direct approach to the disc space without removing the lamina

What condition is the anterior approach especially useful for treating at the cervical and thoracic levels?
a) Lumbar disc herniation
b) Spinal stenosis
c) Scoliosis
d) Osteoporosis

b) Spinal stenosis

What are the two main surgical treatments for cervical disc disease?
a) Laminectomy and lumbar fusion
b) Posterior cervical laminectomy and discectomy, and anterior cervical discectomy and fusion
c) Thoracotomy and anterior thoracic fusion
d) Coccygectomy and spinal decompression

b) Posterior cervical laminectomy and discectomy, and anterior cervical discectomy and fusion

After disc removal in anterior cervical discectomy and fusion, what is used to fuse the bones in the neck?
a) Synthetic implants
b) Cancellous and cortical bone from the iliac crest
c) Bone from the femur
d) No graft material is used

b) Cancellous and cortical bone from the iliac crest

Symptoms of cervical disc extrusion can be:
a) Only acute
b) Only chronic
c) Both chronic or acute due to injury
d) Always asymptomatic

c) Both chronic or acute due to injuries

What might radiographs reveal in cases of cervical disc extrusion or degeneration?
a) Enlarged intervertebral foramen
b) Thickening of the spinal cord
c) Narrowing of the disc space
d) Increased cerebrospinal fluid volume

c) Narrowing of the disc space

*This indicates an extruded (forced out of position) disc or disc degeneration