Cervical Spine Surgery Guidelines

Preoperative Evaluation

The American College of Surgeons recommends obtaining flexion-extension cervical radiographs to definitively rule out segmental instability before proceeding with arthroplasty, with a strength of evidence level of high 1
Dynamic flexion-extension films are mandatory for proper preoperative evaluation, as static MRI cannot adequately assess segmental instability, with a strength of evidence level of high 1

The American Academy of Orthopaedic Surgeons indicates that ACDF is appropriate for patients with moderate to severe foraminal stenosis when conservative management has failed, with a success rate of 80-90% for arm pain relief in cervical radiculopathy, with a strength of evidence level of high 1, 2
The use of anterior cervical plating in ACDF provides improved arm pain relief, faster return to activities of daily living, and reduced pseudarthrosis rates compared to ACDF without instrumentation, with a strength of evidence level of moderate 3, 4

The Centers for Disease Control and Prevention recommends documenting complete resolution of postoperative infection with normal inflammatory markers (ESR, CRP) and clinical examination showing no signs of ongoing infection before proceeding with any implant surgery, with a strength of evidence level of high 1

Obtain flexion-extension cervical radiographs to definitively rule out segmental instability, with a strength of evidence level of high 1
Document complete resolution of the postoperative infection with normal inflammatory markers (ESR, CRP) and clinical examination showing no signs of ongoing infection, with a strength of evidence level of high 1
Proceed with ACDF (not disc replacement) at C4-5 and C5-6 using anterior cervical plating for the 2-level construct, with a strength of evidence level of moderate 3, 4, 1