Techniques for anterior cervical decompression for radiculopathy

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  • 1 Division of Neurological Surgery, University of Alabama, Birmingham, Alabama;
  • 2 Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;
  • 3 Department of Neurosurgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts;
  • 4 Department of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania;
  • 5 Departments of Orthopaedic Surgery and
  • 11 Neurological Surgery, University of Wisconsin, Madison, Wisconsin;
  • 6 Department of Neurosurgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey;
  • 7 Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California;
  • 8 Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York;
  • 9 Department of Neurosurgery, University of California at San Francisco, California; and
  • 10 Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York
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Object

The objective of this systematic review was to use evidence-based medicine to identify the best techniques for anterior cervical nerve root decompression.

Methods

The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to techniques for the surgical management of cervical radiculopathy. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer-review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results

Both anterior cervical discectomy (ACD) and anterior cervical discectomy with fusion (ACDF) are equivalent treatment strategies for 1-level disease with regard to functional outcome (Class II). Anterior cervical discectomy with fusion may achieve a more rapid reduction of neck and arm pain compared to ACD with a reduced risk of kyphosis, although functional outcomes may be similar. Anterior cervical discectomy with fusion is not a lasting means of increasing foraminal or disc height compared to ACD. Anterior cervical plating (ACDF with instrumentation) improves arm pain (but not other clinical parameters) better than ACDF in the treatment of 2-level disease (Class II). With respect to 1-level disease, plating may reduce the risk of pseudarthrosis and graft problems (Class III) but does not necessarily improve clinical outcome alone (Class II). Cervical arthroplasty is recommended as an alternative to ACDF in selected patients for control of neck and arm pain (Class II).

Conclusions

Anterior cervical discectomy, ACDF, and arthroplasty are effective techniques for addressing surgical cervical radiculopathy.

Abbreviations used in this paper: ACD = anterior cervical discectomy; ACDF = anterior cervical discectomy with fusion; ACDFI = anterior cervical discectomy and fusion with instrumentation; LOS = length of stay; NDI = Neck Disability Index; NS = not significant; RCT = randomized controlled trial; RSA = radiostereometric analysis; SF-36 = 36-Item Short Form Health Survery; VAS = visual analog scale.

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Contributor Notes

Address correspondence to: Paul G. Matz, M.D., Neurosurgery and Neurology, LLC, 232 South Woods Mill Road, Chesterfield, Missouri 63017. email: matzpg@yahoo.com.
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