Background: Anterior cervical discectomy and fusion (ACDF) is one of the most beneficial surgical procedures to treat herniated discs. Micromotion is a small motion between the fused adjacent cervical segments. This study compares the micromotion in different cervical movements following ACDF with anterior plating. The data can further enhance cervical stabilization and provide safer long-term results of ACDF. This study examines the degree of micromotion after the ACDF procedure with anterior plating.

Methods: This was a retrospective descriptive study. The study subjects were patients who underwent ACDF with anterior plating at National Brain Center Hospital, Indonesia between February 2019 and January 2022. All patients who were treated with ACDF were included in the study.

Results: There was a total of 41 patients who underwent ACDF surgery from February 2019 to January 2022 meeting the criteria. The shift of the cervical intervertebral disc angles in the flexion position was in the approximate range of 5.25^o – 6.83^o. In the extension position, the angle shift was in the approximate range of 2.75^o – 4.79^o. The cervical vertebrae level with the least alteration was C3 – C4 and with the most alteration was C6 – C7 for flexion and C4 – C5 for extension.

Conclusion: C5 – C6 is the most common site for disc herniation. The stabilization of ACDF could still be increased further. The findings of our evaluation of C5 – C6 are in line with previous studies calculating the flexion-extension range. Micromotion of the adjacent cervical vertebral segment still occurred even after the ACDF procedure and anterior plating. Other stabilization techniques could potentially improve structural outcomes.

Keywords: Anterior cervical approach, anterior cervical discectomy and fusion, cervical range of motion, cervical spine, herniated disc

Background: Ultrasound has been used as an intraoperative imaging option for spine surgery in 1982 and provides benefits as a great imaging modality for assessing soft tissue pathologies in real-time. Along with the development of technology and the presence of advanced imaging modalities, the role of ultrasound is often forgotten. In Indonesia, the role of intraoperative ultrasound has not become a routine modality for spinal tumor surgery despite its advantages and versatility. This study aimed to determine the role of intraoperative ultrasound for intradural spinal tumor surgery and to what extent the intraoperative ultrasound can be utilized based on our experience.

Methods: Two cases of intradural spinal tumors with different pathologies were presented. The initial diagnosis was made through contrast-enhanced magnetic resonance imaging scans. Intraoperative ultrasound was used to show the tumor in a sagittal fashion on three occasions, which were pre-removal, removal, and post-removal phase.

Results: We found intraoperative ultrasound to be a great and versatile modality in spine surgery, especially for intradural spinal tumors. This modality can be used for both total and hemilaminectomy and for both intra- and extramedullary pathology. Real-time evaluation can be performed quickly, radiation-free, cost-effective, and sensitive in assessing soft tissue.

Conclusion: Intraoperative ultrasound is a versatile modality for intradural spinal tumor surgery. The use of this modality needs to be introduced and taught in teaching programs and should become a routine modality for spinal tumor surgery, especially in developing countries where advanced intraoperative imaging modalities are not yet available.

Keywords: intraoperative ultrasound, spine surgery, spine tumor, ultrasonography