ACUT — the Akhnoukh Cervical Ultrasound Technique — is a specialized approach to cervical (neck) endoscopic disc treatment developed by our own Dr. John Akhnoukh. It adds live ultrasound imaging to guide the approach through the delicate structures of the neck. Our pain physicians care for patients across Long Island and northern New Jersey, with offices in Plainview, New Hyde Park, and Ronkonkoma, NY, and Clifton, Montville, and Plainfield, NJ.
The short version
- ACUT is a technique for reaching a herniated or damaged disc in the neck during minimally invasive endoscopic treatment.
- It was designed by Dr. John Akhnoukh to improve efficiency, accuracy, and above all safety when working in the neck.
- It uses ultrasound, alongside standard X-ray guidance, to see the soft tissues and blood vessels of the neck in real time.
- It’s aimed at cervical disc problems causing neck pain or arm symptoms that haven’t responded to conservative care.
What ACUT is
The neck is a crowded, delicate area. Within a small space sit the windpipe, the esophagus, the carotid artery, the jugular vein, and the nerves and discs of the cervical spine. Reaching a damaged disc there safely takes precision. ACUT — short for the Akhnoukh Cervical Ultrasound Technique — was developed by Dr. John Akhnoukh to make that approach more accurate and safer.
Traditional spine access relies on X-ray (fluoroscopy), which shows bone well but not soft tissue. ACUT adds real-time ultrasound, which does show soft tissue — so the physician can see and avoid the blood vessels and other structures around the cervical spine while guiding the approach to the disc. The goal, in Dr. Akhnoukh’s own description of the technique, is to improve efficiency, accuracy, and most importantly safety when accessing the surgical site.
What makes this different: Ultrasound shows soft-tissue structures like arteries and veins that X-ray alone cannot. Using it to map the neck before and during the approach is the core idea behind ACUT — added visualization in one of the body’s most delicate regions.
What it’s used for
ACUT is used as part of cervical endoscopic disc treatment — a minimally invasive way to address a herniated or degenerated disc in the neck. That kind of disc problem can press on nerves and cause neck pain, or pain, numbness, and weakness that travels into the shoulder and arm (cervical radiculopathy).
It’s generally considered when neck or arm symptoms from a cervical disc haven’t settled with conservative care such as physical therapy, medication, and injections. Whether it’s appropriate for you depends on your imaging and your exam — it isn’t right for every neck problem, and we’ll tell you honestly if a different approach fits better.
Are you a candidate?
This approach may be worth discussing when:
- Imaging shows a cervical (neck) disc herniation or degeneration as the source of your symptoms
- You have neck pain, or pain and tingling running into the shoulder or arm
- Conservative care hasn’t given you enough relief
- You’d prefer a minimally invasive option over traditional open neck surgery where appropriate
How cervical care fits with our other disc treatments
ACUT is the neck-specific, ultrasound-guided approach. For disc problems in the mid-back or lower back, our general endoscopic discectomy page covers the minimally invasive options there. If your symptoms are actually nerve pain radiating from the lower back, an epidural steroid injection may be a more appropriate first step. Getting the diagnosis right is what decides the path.
Why patients across Long Island and North Jersey choose Empire
You won’t find the Akhnoukh Cervical Ultrasound Technique at every practice — it was developed here, and you can be evaluated for it close to home rather than at a distant hospital system.
- New York: Plainview, New Hyde Park, and Ronkonkoma — across Nassau and Suffolk
- New Jersey: Clifton, Montville, and Plainfield — serving Passaic, Morris, and Union County communities
- A technique developed by our own Dr. John Akhnoukh
- Interventional pain management and orthopedics under one roof
Insurance
Coverage varies by plan and by location, and we accept many major insurance plans across our New York and New Jersey offices. The simplest way to know exactly what your plan covers is to call — our team will verify your benefits before your visit, so there are no surprises. Whether you’re on Long Island or in North Jersey, reach out and we’ll walk you through your options.
Frequently asked questions
What does ACUT stand for?
ACUT is the Akhnoukh Cervical Ultrasound Technique — a specialized, ultrasound-guided approach to cervical (neck) endoscopic disc treatment developed by Dr. John Akhnoukh.
Why is ultrasound used in the neck?
X-ray shows bone but not soft tissue. Ultrasound shows soft tissue, including the blood vessels around the cervical spine, in real time — so the physician can see and avoid those structures while guiding the approach. That added visualization is the point of the technique.
Is this open neck surgery?
No. It’s part of a minimally invasive, endoscopic approach done through a small opening rather than a large open incision. Your physician will explain exactly what’s involved for your situation.
What symptoms does it address?
Neck pain and arm symptoms — pain, numbness, or tingling into the shoulder and arm — caused by a herniated or degenerated disc in the neck that hasn’t responded to conservative care.
Who developed ACUT?
Dr. John Akhnoukh, one of Empire’s pain physicians, developed the technique to improve the efficiency, accuracy, and safety of accessing the cervical spine.
How do I know if I’m a candidate?
It depends on your imaging and exam. The only way to know is an evaluation, where we confirm the source of your symptoms and discuss whether this approach or another option fits you best.
Neck or arm pain from a cervical disc?
Our pain physicians see patients across Long Island, NY and northern New Jersey. We’ll confirm where your symptoms are coming from and tell you honestly whether an approach like ACUT is right for you.
New York: 516-229-1443 | New Jersey: 732-630-7246
Identifying the Surgical Level
Initially, fluoroscopy is used to accurately identify the surgical level(s) for treatment. If the shoulders are obstructing the view, the shoulders should be taped to caudally displace them with an appropriate amount of tension. We start off in a lateral orientation in order to count the cervical vertebral bodies and identify the appropriate disc space(s). Once identified, the patient should be marked using a marking pen at the lowest disc space.
Patient Preparation and Positioning:
As with any surgery, Standard protocols are used for sterility and draping of the patient. The sheets and drapes utilized should only expose the anterior portion of the neck of the side, in which the surgery will take place. For the lateral approach, the practitioner should draw an imaginary line from the mastoid process to the midclavicular line of the appropriate side longitudinally and from this line out to the contralateral side of the trachea transversely.
Ultrasound Guidance and Anatomical Mapping
After sterile precautions, the ultrasound is placed in a transverse orientation over the anterior aspect of the patient’s neck on the side of the designated approach. It is important to identify the following anatomical landmarks: trachea, esophagus, carotid artery, internal jugular vein, transverse process and depending on the desired disc space, the thyroid and its associated arteries and veins. The goal is to improve safety and efficacy when accessing the cervical spine.
Tracheal Deviation and Initial Device Placement
In beginning the surgery, we utilize the ultrasound in the orientation previously described to apply pressure on the trachea to deviate it away from the surgical site to the contralateral side and identify the carotid artery laterally.
Safety Consideration Before Device Placement
NOTE: make sure to identify any collateral vessels or thyroid vessels before penetrating the skin. Utilizing an out-of-plane technique, we enter with the 25 gauge needle lateral to the trachea and medial to the carotid artery avoiding any additional vessels. The out-of-plane technique, if used appropriately, allows us to visualize the needle tip and the shadow of the shaft of the needle. Using the local anesthetic we can then inject 5-10 mL in the tract to the surgical site, which will also assist in displacing the carotid artery further laterally.
Advancing the Access Device
At this point, create a small incision to exchange the needle for the access device under direct visualization, using the same out-of-plane technique, between the trachea and carotid artery. As the device approaches the surgical site, it is important that we course medially with the intent of resting the device on the appropriate disc or adjacent vertebral body, which typically provides a degree of resistance. It is crucial that we identify the depth of the device as it passes both the carotid artery and trachea utilizing the markings on the access device. If at any point the device is withdrawn past this specific marker, it is recommended to utilize ultrasonography to re-access the surgical site in order to avoid puncturing any vital structures.
Fluoroscopic Confirmation
Once we have passed these vital structures and have met the appropriate resistance, we will utilize fluoroscopy again. Using fluoroscopy in the lateral position, we want to make sure that we are at the appropriate level and immediately anterior to the disc. We then will utilize the fluoroscopy in an AP position to identify the device immediately lateral to the spinous process, which should be in the center of the disc. At this point, we can penetrate the disc space and administer contrast, with or without antibiotics, to confirm that we are in the contained disc space.
Guide Wire Placement and Cannula Insertion
After we complete intradiscal access, we can now exchange the access device over a guide wire. We then utilize an 11 mm blade scalpel in a longitudinal fashion immediately cephalad to the guide wire in order to exchange a trochar, dilator and working cannula, over the guide wire to avoid a dermal tear. Once, the trochar is in the 1/3 marker of the disc in a lateral view, the dilator can be removed. Additional tools can be introduced through the cannula to perform an endoscopic discectomy, and/or an ablation of the nucleus pulposus and annuloplasty using radiofrequency.
Treating Additional Levels
Depending on the proximity of additional levels, the guide wire may be reinserted via an exchange through the cannula for the access device. The access device can be withdrawn to immediately anterior to the disc and can be walked up the next level. If unable to access the levels above with the same incision, the process can be restarted from the beginning by removing all the tools and creating a new access site.
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Medicare and Medicaid are not accepted at our New Jersey locations. Not sure about your plan? Call us and we'll verify before your visit.
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Meet Our Pain Management & Orthopedic Specialists
Dr. Monica Misak
Interventional Pain Specialist
Dr. James Yu, D.O.
Board Certified Anesthesiologist
Board Certified Interventional
Pain Management Physician
Dylan J. O'Rourke
Certified Physician Assistant
Pain Conditions Affecting Daily Life
Improve your quality of life with our comprehensive approach to pain management
We are dedicated to finding individualized treatment options tailored to fit your needs. Our team is dedicated to helping you lead a productive and active life, free from pain and disruption.
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