Dr. Jonathan J. Rasouli delivers a focused, high-yield masterclass on cervical decompression and fusion that feels tailor-made for residents, fellows, and early-career spine surgeons looking to connect anatomy, imaging, and real-world decision making.
Dr. Rasouli starts by demystifying the full spectrum of degenerative cervical disease, from “everyone has neck pain” axial complaints to truly surgical radiculopathy and myelopathy. He clearly explains when patients belong in structured conservative care and when red flags should push you straight to urgent imaging or the ER, using memorable clinical vignettes like the stable radiculopathy patient who suddenly develops severe hand weakness.
The core case patterns
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Pain‑dominant radiculopathy with concordant imaging is framed as the classic indication for ACDF, with a strong emphasis on decompressing the uncovertebral joint to avoid failed surgery from residual foraminal stenosis.
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Multilevel myelopathy with gait disturbance and “numb, clumsy hands” is presented as a fundamentally surgical problem, where timing matters because late presentations have a clearly worse natural history.
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“Burnt‑out” multilevel spondylosis and kyphotic deformity are used to show why posterior approaches, laminoplasty, or combined constructs can be superior to an anterior‑only strategy in selected patients.
Technique pearls that stand out
Dr. Rasouli walks through a modern Smith–Robinson ACDF step by step—from skin‑crease incision planning to Caspar pin placement and PLL resection—highlighting small decisions that make a big difference, like always working medially to avoid getting “lost” in the neck. He contrasts this with the historical Cloward dowel technique, using it to show how far cervical fusion has evolved in terms of deformity correction and long‑term biomechanics.
What makes the talk especially motivating is his open discussion of complications: neck hematoma as a true airway emergency, esophageal injuries that must be assumed until excluded, and pseudoarthrosis patterns that push him toward posterior revision rather than repeat anterior surgery. He threads this into a long‑term view on adjacent segment disease, explaining why he now treats obviously degenerated neighbor levels more aggressively instead of “watching” discs that are almost guaranteed to fail in a few years.