the treatment of spinal disorders at John Hopkins University.

I wanted to share with you a video presentation regarding a

common condition that we encounter quite frequently - cervical disc herniation.

Patients usually present with neck pain,

arm pain, difficulty with fine mtor movements

of the hand, weakness in the hand, gait and stability and urinary problems.

This particular patient was found to have a

large cervical discrimination which was compressing her spinal

cord that we treated via surgical removal using

a small incision in the neck and microscopic guidance.

Here is the intra operative video taken during surgery.

The patient in this illustration is lying, eh, on their back

and a small insertion has been performed in the neck.

The vertebral bodies are exposed and so is the disk.

You can see us here drilling through the disk.

The drilling continues until we encounter the bones or the

end plates on the other side of the disc, which is where the spinal cord would be.

And here's another illustration of where the

vertebral bodies are and where the disc is.

This procedure is done under microscopic guidance.

And here you can see that we are removing disc pieces

that have herniated through the annulus and are compressing the spinal cord.

And these are 2 small pieces, 2 medium sized pieces that we have removed

from there.

The decompression continues.

As you can see with the usage of multiple instruments,

and there we will keep on going until we see the spinal

chord which is the best measure of decompression of the spinal chord.

As we are trying to remove the

last pieces of disc we

encounter a piece that has

herniated

backwards and is causing compression of the spinal cord.

And with the use of a nerve hook,

we are going to tease out that last piece that has herniated.

And the nerve hook has not been brought to the

field yet, as we are still trying to remove the

last pieces of the annulus prior to going

for the large piece fragment that has herniated.

So this is an illustration of the large herniated

disc fragment which we can feel with our [UNKNOWN]

and here we are gonna go with the nerve hook and see if we can tease it out.

We will place the nerve hook right on the spinal cord and

see if we can remove that piece and here comes that piece.

It's a large piece of disc that was straight on

the spinal cord causing significant compression of the spinal cord.

Here's another couple of small pieces as well that are also coming out.

That's not uncommon for discs to come in fragments as you can see here.

The large piece has been removed and the small

pieces as well which were compressive have been removed.

Another piece

is discovered

and has been

teased off of the spinal cord.

And here goes another big one.

At this point you can see that the spinal cord has been decompressed.

You can see the spinal cord and its small vessel on top of it.

And it is completely decompressed and all the disk fragments have been removed.

And that's another illustration of the spinal

cord which is that white, glossy structure

and at the end we would place a bone graft followed by a titanium plate.