OUTCOME OF CERVICAL DISECTOMY AND FUSION WITH STABILIZATION IN SINGLE LEVEL CERVICAL DISC

Authors

  • Riaz A Raja
  • Muhammad Naeem-ur- Razaq
  • Saleem Ahmad Shaikh
  • Hameed Khan

Abstract

Background: Cervical radiculopathy is a common and distressing problem. Only those patients whofailed conservative treatment should undergo surgery. The anterior cervical disectomy is theprocedure which offers maximal exposure of the disc space. It easily removes the portion of discwhich compresses the nerve root. Possibility of developing late kyphosis from disc space collapsesupported the fusion procedure after single level disectomy. The goal of instrumentation is to provideimmediate stability, increase fusion rate, prevent graft failure, improve rehabilitation process andpossibly no need for external orthosis. Objective of study was To see the results and complications ofcervical disectomy thru anterior approach and fusion and stabilisation with titanium made plate.Methods: This was a prospective study, comprised of 32 patients admitted during period from 2005–2008. Patients presented with radiculopathy or radiculo-myelopathy were evaluated. MRI wascarried out in all the cases. Each patient was carefully evaluated to confirm clinico-radiologicalcorrelation and patients with significant disc and failure of conservative treatment were included inthe study. Results: Males were 28 (87.5%) and female were 4 (12.5%). Twenty patients (62.5%)were in fourth decade. C5-6 was involved in 18 (56.25%) patients. No significant postoperativecomplications noted. Persistent neck and back pain noted in patients in disectomy group withoutplating. Conclusion: Anterior cervical disectomy, fusion and stabilisation with plating is a safe andeasy procedure in single level cervical disc disease without significant complications.Keywords: Cervical disectomy, fusion, anterior approach, cervical platting

References

Lied B, Roenning PA, Sundseth J, Helseth E. Anterior

cervical discectomy with fusion in patients with cervical disc

degeneration: a prospective outcome study of 258 patients

(181 fused with autologous bone graft and 77 fused with a

PEEK cage). BMC Surg 2010;10:10.

J Ayub Med Coll Abbottabad 2010;22(2)

http://www.ayubmed.edu.pk/JAMC/PAST/22-2/Raja.pdf 183

Jenis LG, Kim DH, An HS. Cervical Disc Disease In: Frymoyer

JW, Wiesel SW. The Adult & Pediatric Spine. 3rd edition, Vol-2

Lippincott Williams & Wilkins; 2004. p.689–700.

Watters WC, Levinthal R. Anterior cervical discectomy with

and without fusion. Spine 1994;19:2343–7.

An H, Evanich C, Nowicki B, Haughton V. Ideal thickness

of Smith-Robinson anterior cervical fusion. Spine

;18:2043–7.

Cloward R. The anterior approach for removal of ruptured

cervical disc. J Neurosurg 1958;15:602–17.

Simmons E, Bhalla S. Anterior cervical discectomy and

fusion. J Bone Joint Surg 1969;51B:255–37.

Bailey R, Badgley C. Stablization of cervical spine by

anterior fusion. J Bone Joint Surg 1960;42A:565–94.

Herkowitz H. Internal fixation for degenerative cervical spine

disorders. In: Weisel S, (ed). Seminar in spine surgery-cervical

disc disease. Philadelphia: WB saunders;1995.p. 57–60.

Connolly PJ, Esses SI, Kostuik JP. Anterior cervical fusion:

Outcome analysis of patients fused with or without anterior

cervical plates. J Spinal Disord 1996; 3:202–6.

Gore DR, Sepic SB. Anterior discectomy and fusion for

painful cervical disc disease. A report of 50 patients with an

average followup of 21 years. Spine 1998;23:2047–51.

Chestnut RM, Abitbol JJ, Garfin SR. Surgical management

of cervical radiculopathy. Orthop Clin North Am

;23:461–74.

Zdeblick TA, Cooke ME, Wilson D, Kunz DN, McCabe R.

Anterior cervical discectomy, fusion and plating. A

comparative animal study. Spine. 1993;14:1974–83

Voorhies RM. Managing the more common cervical

disorders. IM Int Med 1996;17(10):18–41.

Ebersold MJ, Pare MC, Quast LM. Surgical treatment for

cervical spondylotic myelopathy. J Neurosurg 1995;82:745–51.

Rosenorn J, Hansen EB, Rosenorn MA. Anterior cervical

discectomy with and without fusion. J Neurosurg

;59:252–5.

Ullman JS, Camins MB, Post KD. Complications of cervical

disk surgery. Mt Sinai J Med 1994;61:276–9.

Bohlamann H, Emery SE, Goodfellow DB, Johnes PK.

Robinson anterior cervical disectomy and arthrodesis for

cervical radiculopathy. J Bone Joint Surg (Am)

;75:1298–307.

Lunsford LD, Bissonette DJ, Jannetta PJ, Sheptak PE, Zorub

DS. Anterior surgery for cervical disc disease. Part 1:

Treatment of lateral cervical disc herniation in 253 cases. J

Neurosurg 1980; 53:1–11.

Herkowitz HN, Kurz LT, Overholt DP. Surgical management

of cervical soft disc herniation: A comparison between

anterior and posterior approach. Spine 1990;15:1026–30.

Gore DR, Sepic SB. Anterior cervical fusion for degenerated

or protruded discs. A review of one hundred forty-six

patients. Spine 1984;9:667–71.

Connolly ES, Seymour RJ, Adams JE. Clinical evaluation of

anterior cervical fusion for degenerative cervical disc disease.

J Neurosurg 1965;23:431–7.

Dowd GC, Wirth FP. Anterior cervical disectomy: is fusion

necessary? J Neurosurg 1999;90:8–10.

Savolainen S, Rinne J, Hernesniemi J. A prospective

randomized study of anterior single level cervical disc

options with long term follow-up: surgical fusion is

unnecessary. Neurosurgery 1998;43(1):51–5.

Zdeblick TA, Hughes SS, Riew KD, Bohlman HH. Failed

anterior cervical disectomy and arthrodesis. J Bone Joint

Surg (Am) 1997;79:523–32.

Caspar W, Geisler FA, Pitzer T, Johnson TA. Anterior cervical

plate stabilization in one- and two-level degenerative disease:

overtreatment or benefit? J Spinal Disord 1998;11:1–11.

Grob D, Peyer J, Dvorak J. Anterior cervical spine fusion:

With or without instrumentation? A prospective randomized

study. Presented at the Cervicall Spine Research Society

twenty-fifth annual meeting. Rancho Mirage, CA December

[Abstract number 25].

Kostuik JP, Connolly PJ, Esses SI, Suh P. Anterior cervical

plate fixation with the titanium hollow screw plate system.

Spine 1993;18:1273–8.

Phillips FM, Carlson G, Emery SE, Bohlman HH. Anterior

cervical psudoarthrodosis: natural history and treatment.

Spine1997;22:1585–9.

Lowery GL, Swank ML, McDonough RF. Surgical revision

for failed anterior cervical fusions: articular pillar plating or

anterior revision? Spine 1995;20:2436–41.

Flynn T. Neurologic complications of anterior cervical

interbody fusion. Spine 1982;7:536–9.

Smith M, Emery S, Dudley A, Murray KJ, Leventhal M.

Vertebral artery injury during anterior decompression of the

cervical spine- a retrospective review of ten patients. J Bone

Joint Surg 1993;75:410–5.

Heeneman H. Vocal cord paralysis following approaches to

the anterior cervical spine. Laryngoscope.1973;83:17–21.

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Published

2010-06-01