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cervical total dis replacement essentially the surgical approach for a tcdr is exactly the same as an acdf the patient is first positioned supine upon the operative table and subsequently placed under general endot tral anesthesia after this the surgical incision site is marked based upon surgeon preference this can be a transverse incision in a skin crease at the proposed level of dis replacement or a longitudinal incision if a larger operative field is required the approach is left or right sided once again based upon surgeon preference optimal positioning of the implant should reproduce the natural lordosis of the disk space to be replaced to achieve this gentle extension of the neck with a roll underneath the shoulders is performed remember cervical myelopathy can be acutely worsened by this position if there is a concern that interoperative radiographic visualization of the cervical spine may be blocked the shoulders should be pulled down and held in place for example with tape th
