• General Principles for Surgery
• Surgical Technique

1. Distract the intervertebral space to achieve a spring action before placement of the intervertebral bone graft. The compressive force on the graft along with friction between the graft and vertebral bodies secures the graft in place.
2. Fashion the vertebral endplates parallel to each other with a curette or burr. Remove the vertebral osteophytes and herniated discs using standard surgical techniques to perform the segmental decompression. Having the surfaces of the bone graft parallel to the vertebral bodies eliminates anterior, posterior and lateral forces on the graft that may cause it to move in the post-op period. Also, the parallel shape exactly fits the graft and provides the maximum surface area of contact to promote rapid bony growth from the vertebral body into the graft interval.
3. Completely remove the cartilaginous endplates to enhance bony healing. TIP: Prior to removing the posterior longitudinal ligament, all shaping of the interdiscal space should be completed. The posterior longitudinal ligament acts as a good protector of the underlying dura and neural elements.
4. Recess the graft posterior (1-3mm) to the anterior cortex of the vertebral bodies. This aids in locking the graft in place behind the anterior cortex when even a minimal amount of settling occurs.
5. As with any allograft product, an anterior cervical plate may be utilized to provide internal stabilization and restored disc space height in addition to that provided by the intervertebral graft.

OPTIMAL CONTACT

POOR CONTACT

Surgical Technique

1. Obtain distraction of the adjacent vertebral bodies and shape the lens-shaped disc space into a parallel slot using a curette or burr.
2. Determine the graft width and depth by gently impacting an appropriate trial spacer into the disc space (Figure 1). This step will often remove minor irregularities in the shaping of the endplates.
3. Release the vertebral distraction and assess the stability of the trial. If movement is present, then use a larger trial. If the next size trial is too large, then contact area is insufficient. Remove the trial spacer and further prepare the endplates to make them parallel. (Lateral fluoroscopy or radiography often aids in evaluating the fit between the trial and the vertebral bone.)
4. Rehydrate the Graftech^® Cervical Spacer as directed. TIP: Grafton^® DBM may be infused into the dense, cancellous graft to promote bone healing.
5. Introduce the Graftech
^® Cervical Spacer into the disc space with the introducer (Figure 2).
6. Gently impact the graft with the bone tamp until the graft is fully seated, recessed approximately 1-3 mm from the anterior cortex (Figures 3 and 4). If a plate is used, the graft can alternately be left flush with the anterior cortex.