Anterior cervical discectomy without interbody bone graft

1972 ◽  
Vol 37 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Michael G. Murphy ◽  
Mokhtar Gado

✓ Twenty-six patients had anterior cervical discectomy without interbody bone graft for lateral cervical disc syndrome. Twenty-four (92%) had a good clinical result. Radiological follow-up was obtained in 20 cases. The incidence of fusion was 72% for discectomy at a single level. Patients undergoing discectomy at two adjacent levels were too few to permit a statement regarding the incidence of fusion. In those cases of incomplete fusion, dynamic films demonstrated stability at the operated site. Half of the cases who had posterior osteophytes preoperatively showed some degree of resorption after 12 months. Neither incomplete fusion nor failure of osteophyte resolution was incompatible with a good clinical result.

1977 ◽  
Vol 47 (4) ◽  
pp. 551-555 ◽  
Author(s):  
Donald H. Wilson ◽  
Dwight D. Campbell

✓ Anterior cervical discectomy without bone grafting may become the procedure of choice for acute cervical disc protrusions. This operation was performed on 71 patients, all of whom were followed from 1 to 6 years. Complications were minor in nature. The results were excellent and sustained.


2003 ◽  
Vol 98 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Michael Payer ◽  
Daniel May ◽  
Alain Reverdin ◽  
Enrico Tessitore

Object. The authors sought to evaluate retrospectively the radiological and clinical outcome of anterior cervical discectomy followed by implantation of an empty carbon fiber composite frame cage (CFCF) in the treatment of patients with cervical disc herniation and monoradiculopathy. Methods. Twenty-five consecutive patients (12 men, 13 women, mean age 45 years) with monoradiculopathy due to cervical disc herniation were treated by anterior cervical discectomy followed by implantation of an empty CFCF cage. On lateral flexion—extension radiographs segmental stability at a mean follow up of 14 months (range 5–31 months) was demonstrated in all 25 patients, and bone fusion was documented in 24 of 25 patients. The mean anterior intervertebral body height was 3.4 mm preoperatively and 3.8 mm at follow up in 20 patients. In these patients the mean segmental angle (angle between lower endplate of lower and upper vertebra) was 0.9° preoperatively and 3.1° at follow up. In the remaining five patients preoperative images were not retrievable. Self-scored neck pain based on a visual analog scale (1, minimum; 10, maximum) changed from a preoperative average of 5.6 to an average of 2 at follow up; radicular pain was reduced from 7.7 to 2.1 postoperatively. Analysis of the SF12 questionnaires showed a significant improvement in both the physical capacity score (preoperative mean 32.4 points; follow up 46 points) and the mental capacity score (preoperative mean 45.8 points; follow up 57.5 points). Conclusions. Implantation of an empty CFCF cage in the treatment of cervical disc herniation and monoradiculopathy avoids donor site morbidity associated with autologous bone grafting as well as the use of any supplementary material inside the cage. Restoration or maintenance of intervertebral height and thus segmental lordosis and a very high rate of segmental stability and fusion are achieved using this technique.


2005 ◽  
Vol 2 (5) ◽  
pp. 521-525 ◽  
Author(s):  
Maxwell Boakye ◽  
Praveen V. Mummaneni ◽  
Mark Garrett ◽  
Gerald Rodts ◽  
Regis Haid

Object. The authors reviewed clinical and radiographic outcomes in patients who had undergone anterior cervical discectomy and fusion (ACDF) involving the placement of polyetheretherketone (PEEK) spacers filled with recombinant human bone morphogenetic protein (rhBMP)—2. Methods. Data obtained in 24 cases were retrospectively evaluated. The follow-up period ranged from 12 to 16 months (mean 13 months). Fifteen patients presented with radiculopathy, eight with myeloradiculopathy, and one with quadriparesis. Single-level ACDF was performed in 12 patients, two-level ACDF in nine, and three-level ACDF in three. Clinical outcomes were assessed using Odom criteria, and fusion was assessed by examining flexion—extension radiographs and computerized tomography scans in cases in which arthrodesis was questionable. Follow-up data were available for 23 patients. One patient died of medical complications unrelated to surgery 4 weeks after ACDF. Clinical outcomes were rated as good/excellent in 22 patients (95%) and fair in one (5%). Solid radiographically documented fusion, with evidence of solid bridging bone and no instability on flexion—extension x-ray films, was present in all cases. Complications included transient recurrent laryngeal nerve injury in one case, transient C-5 paresis in one, cerebrospinal fluid leakage in one, and transient dysphagia in two. Conclusions. Analysis of the results indicated that ACDF involving an rhBMP-2—filled PEEK spacer leads to good clinical outcomes (by Odum criteria) and solid fusion (even in multilevel cases) while avoiding the complications associated with harvesting iliac crest bone grafts.


2003 ◽  
Vol 98 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Bikash Bose

Object. Placing instrumentation in the anterior cervical spine is a common procedure. The bi- and unicortical systems currently available, however, have distinct advantages and disadvantages. The author reports a prospective series in which a new dynamized anterior cervical fixation system was evaluated. Methods. Thirty-seven patients underwent anterior cervical discectomy and fusion in which the DOC ventral cervical stabilization system was used for indications including cervical spondylotic radiculopathy, disc herniation, trauma, and myelopathy. Patients underwent anterior cervical discectomy and interbody fusion and/or corpectomy. Preoperative and postoperative clinical data included assessment of spinal cord and nerve root deficit, function, neck pain, and arm pain. Preoperative and postoperative radiographic data included sagittal angle, translation, and settling of the graft. Fusion status was determined by the presence of trabecular bridging bone on plain anteroposterior and lateral cervical radiographs. At a mean follow-up time of 1.3 years, postoperative neck or arm pain was resolved in 52% of the patients, restriction on function was mild or absent in 88%, and fusion was successful in 80% of patients and 88% of the treated levels. There was one implant-related complication, one significant dysphagia complication, and a 10.8% donor graft site complication rate. Conclusions. The use of this system led to a high percentage of pain relief and radiographic fusion. The sagittal angle was controlled while allowing for graft settling. There were no implant failures.


1998 ◽  
Vol 89 (5) ◽  
pp. 839-843 ◽  
Author(s):  
Thomas J. Manski ◽  
Michael D. Wood ◽  
Stewart B. Dunsker

✓ The authors report a rare case of bilateral vocal cord paralysis following anterior cervical discectomy and fusion (ACD/F) in a patient who had a preexisting, clinically silent, and unrecognized unilateral vocal cord paralysis from a remote cardiac surgical procedure. The patient, a 41-year-old woman who developed acute respiratory stridor and respiratory insufficiency at the time of extubation after undergoing a C6–7 ACD/F, required emergency reintubation and ventilation. Otolaryngological evaluation revealed bilateral vocal cord paralysis with one vocal cord showing evidence of acute paralysis and the other showing evidence of chronic paralysis. She eventually required a permanent tracheotomy. The patient had undergone previous cardiac surgical procedures to correct Fallot's tetralogy as a neonate and as a child. At those times, there were no recognized symptoms of transient or permanent vocal cord dysfunction. This case emphasizes the importance of identifying patients with preexisting unilateral vocal cord paralysis before performing neurosurgical procedures such as ACD/F, which can place the only functioning vocal cord at risk for paralysis. Guidelines for identifying patients with preexisting unilateral vocal cord paralysis and for modifying the surgical procedure for ACD/F to prevent the catastrophic complication of bilateral vocal cord paralysis are discussed.


2019 ◽  
Vol 7 (17) ◽  
pp. 2824-2828 ◽  
Author(s):  
Hamdi Mostafa ◽  
Mohsen Lotfi ◽  
M. Wahid

BACKGROUND: Cervical herniation is commonly treated by anterior cervical discectomy and fusion (ACDF) if conservative management has failed in relief of the patient's symptoms. Disc fusion is needed after ACDF as anterior longitudinal ligament will be absent after doing the operation, especially if multiple levels are needed. The occurrence of complications as cage subsidence and adjacent segment failure related to the length of follow up as they are increasing in percentage is directly proportional to the length of follow up. AIM: Analysis of the results for patients who underwent 3 levels of ACDF with cage fusion for short term and long term follow up in multiple centres as the visual analogue score for neck pain & brachialgia. METHODS: This retrospective cohort series of 68 patients selected out of 136 patients suffering from 3 levels of degenerative cervical disc disease who were unresponsive to adequate conservative therapy. All cases were treated at one of the neurosurgery departments of 3 different hospitals (Naser institute for research and treatment hospital, Haram hospital for research and treatment and Misr university for science and technology) by the same surgical team in the period from February 2012 to February 2017. RESULTS: We found in this study;68 patients fulfilling the inclusion criteria, of the 29 patients underwent 3 levels of ACDF starting from C3-4 (42.65%) and 39 patients who underwent 3 levels of ACDF starting from C4-5 (57.35%). Clinical assessment for VAS pain score for both neck pain and radiculopathy were done before the surgery and immediately post-operative and during each time follow up visit and we found statistically significant immediate postoperative improvement. (P ˂ 0.05) CONCLUSION: Stand-alone three levels of an anterior cervical discectomy with cage fusion technique improved the clinical outcomes on long term follow up.


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