Below the skin, the trachea and esophagus are towards the midline, while the carotid artery and jugular vein is towards the outside. In between these structures is the interval where the anterior portion of the spinal bones (vertebrae) can be felt. Retractors are placed to hold aside the muscles, as well as the other vital structures in the neck. A sharp scalpel is then used to cut through the disc. The disc is then removed with a “grabbing” instrument called a pituitary rongeur. After the discs are removed, a motorized instrument called a bur is used to remove the anterior portion of the vertebral body. The bur as well as other sharp instruments are used to remove bone until the covering over the spinal cord (dura) is seen. By removal of this bone, the pressure on the spinal cord and nerves is removed.