Anterior Cevical Discectomy and Fusion (ACDF) is a procedure in which a surgeon (orthopedic or neuro) removes the offending disc(s) and replaces it with a bone graft and often involves using a plate and screws to ensure the fusion. As with all surgeries, it is not without its complications which include but are not limited to: paraparesis, paraplegia, quadriplegia, and damage to the recurrent laryrngeal nerve (CN X, most common in C4-C7). Order of the procedure is as follows:

  1. Induction of anesthesia/intubation
  2. Incision
  3. Exposure
  4. Decompression/discectomy
  5. Fusion (placement of the bone graft)
  6. Plate and screws
  7. Closure
  8. Emergence/extubation

Inraoperative neuromonitoring (IONM) monitors the sensory and motor aspects as well as depth of anesthesia during these procedures in order to provide the safest care possible for the patient. Sensory Evoked Potentials (SEPs), motor evoked potentials (TcMEPs/MEPs), electromyography (EMG), and electroencephalography (EEG) are the modalities used to ensure patient safety and reduce the risk of adverse outcomes.

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