Anterior cervical discectomy: is fusion necessary?

Restricted access

Object. A prospective, randomized trial was performed to compare the efficacy of anterior cervical discectomy (ACD) with ACD and fusion (ACDF) for the treatment of cervical spondylosis in patients with neurological compromise.

Methods. Forty-four patients underwent ACD and 40 underwent ACDF. Operative time and length of hospital stay were shorter and there was less need for analgesia in the ACD group. It was found that whereas the incidence of fusion was greater in the ACDF group compared to the ACD group (97 compared with 70%, respectively; p < 0.01), patient satisfaction and a return to preoperative activity level was similar between groups.

Conclusions. Analysis of the results suggests that the addition of a fusion procedure may be unnecessary.

Article Information

Address reprint requests to: Fremont P. Wirth, M.D., Savannah Neurological Institute, 4 Jackson Boulelvard, Savannah, Georgia 31405.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Upper Left: Bar graph showing demographic data between the two patient groups. Upper Right: Bar graph depicting the distribution of preoperative symptoms between the two patient groups. Lower Left: Bar graph showing findings at physical examination between the two patient groups. Lower Right: Bar graph depicting the type of preoperative therapy that each patient group underwent.

  • View in gallery

    Bar graph showing the location and number of disc levels surgically treated, according to patient group.

  • View in gallery

    Plain x-ray films depicting (left) ACD of C5–6 4 years postoperatively and (right) ACDF of C6–7 12 weeks postoperatively.

References

1.

Bailey RWBadgley CE: Stabilization of the cervcial spine by anterior fusion. J Bone Joint Surg (Am) 42:5655941960Bailey RW Badgley CE: Stabilization of the cervcial spine by anterior fusion. J Bone Joint Surg (Am) 42:565–594 1960

2.

Brieg ATroup JD: Focal intramedullary tension in patients with cord lesion and its surgical relief by spinal cord relaxation. Lancet 1:7397401984Brieg A Troup JD: Focal intramedullary tension in patients with cord lesion and its surgical relief by spinal cord relaxation. Lancet 1:739–740 1984

3.

Cloward RB: The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:6026171958Cloward RB: The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617 1958

4.

Concha SMcQueen JD: Anterior cervical fusions for spondylotic myelopathy. Spine 2:1471501977Concha S McQueen JD: Anterior cervical fusions for spondylotic myelopathy. Spine 2:147–150 1977

5.

Connolly ESSeymour RJAdams JE: Clinical evaluation of anterior cervical fusion for degenerative cervical disc disease. J Neurosurg 23:4314371965Connolly ES Seymour RJ Adams JE: Clinical evaluation of anterior cervical fusion for degenerative cervical disc disease. J Neurosurg 23:431–437 1965

6.

Crandall PHGregorius FK: Long term followup of surgical treatment of cervical spondylotic myelopathy. Spine 2:1391461977Crandall PH Gregorius FK: Long term followup of surgical treatment of cervical spondylotic myelopathy. Spine 2:139–146 1977

7.

Dandy WE: Loose cartilage from intervertebral disk simulating tumor of the spinal cord. Arch Surg 19:6606721929Dandy WE: Loose cartilage from intervertebral disk simulating tumor of the spinal cord. Arch Surg 19:660–672 1929

8.

Dunsker SB: Anterior cervical discectomy with or without fusion. Clin Neurosurg 24:5165211977Dunsker SB: Anterior cervical discectomy with or without fusion. Clin Neurosurg 24:516–521 1977

9.

Ebersold MJPare MCQuast LM: Surgical treatment for cervical spondylitic myelopathy. J Neurosurg 82:7457511995Ebersold MJ Pare MC Quast LM: Surgical treatment for cervical spondylitic myelopathy. J Neurosurg 82:745–751 1995

10.

Hirsch C: Cervical disc rupture: diagnosis and therapy. Acta Orthop Scand 30:1721861960Hirsch C: Cervical disc rupture: diagnosis and therapy. Acta Orthop Scand 30:172–186 1960

11.

Lunsford LDBissonette DJJannetta PJet al: Anterior surgery for cervical disc disease, Part 1: treatment of lateral cervical disc herniation. J Neurosurg 53:1111980Lunsford LD Bissonette DJ Jannetta PJ et al: Anterior surgery for cervical disc disease Part 1: treatment of lateral cervical disc herniation. J Neurosurg 53:1–11 1980

12.

Martins AN: Anterior cervical discectomy with and without interbody bone graft. J Neurosurg 44:2902951976Martins AN: Anterior cervical discectomy with and without interbody bone graft. J Neurosurg 44:290–295 1976

13.

Mixter WJBarr JS: Rupture of the intervertebral disc with involvement of the spinal canal. NEJM 211:2102151934Mixter WJ Barr JS: Rupture of the intervertebral disc with involvement of the spinal canal. NEJM 211:210–215 1934

14.

Murphy MGGado M: Anterior cervical discectomy without interbody bone graft. J Neurosurg 37:71741972Murphy MG Gado M: Anterior cervical discectomy without interbody bone graft. J Neurosurg 37:71–74 1972

15.

Robinson RASmith GW: Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Johns Hopk Hosp Bull 96:2232241955 (Abstract)Robinson RA Smith GW: Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Johns Hopk Hosp Bull 96:223–224 1955 (Abstract)

16.

Rosenorn JHansen EBRosenorn MA: Anterior cervical discectomy with and without fusion: a prospective study. J Neurosurg 59:2522551983Rosenorn J Hansen EB Rosenorn MA: Anterior cervical discectomy with and without fusion: a prospective study. J Neurosurg 59:252–255 1983

17.

Ullman JSCamins MBPost KD: Complications of cervical disk surgery. Mt Sinai J Med 61:2762791994Ullman JS Camins MB Post KD: Complications of cervical disk surgery. Mt Sinai J Med 61:276–279 1994

18.

Voorhies RM: Managing the more common cervical disorders. IM 17:18411996Voorhies RM: Managing the more common cervical disorders. IM 17:18–41 1996

19.

Watters WCLevinthal R: Anterior cervical discectomy with and without fusion: results, complications, and long-term follow-up. Spine 19:234323471994Watters WC Levinthal R: Anterior cervical discectomy with and without fusion: results complications and long-term follow-up. Spine 19:2343–2347 1994

20.

White AAPanjabi MM: Biomechanical considerations in the surgical management of cervical spondylotic myelopathy. Spine 13:8568601988White AA Panjabi MM: Biomechanical considerations in the surgical management of cervical spondylotic myelopathy. Spine 13:856–860 1988

21.

Wiberg J: The effects of surgery on cervical spondylotic myelopathy. Acta Neurochir 81:1131171986Wiberg J: The effects of surgery on cervical spondylotic myelopathy. Acta Neurochir 81:113–117 1986

22.

Wirth FP. High speed drills in Wilkins RHRengarchary SS (eds): Neurosurgery. New York: McGraw-Hill1996 pp 591594Wirth FP. High speed drills in Wilkins RH Rengarchary SS (eds): Neurosurgery. New York: McGraw-Hill 1996 pp 591–594

23.

Yong-Hing KKirkaldy-Willis WH: The three joint complex in International Society for the Study of the Lumbar Spine (eds): The Lumbar Spine. Philadelphia: Saunders1990 pp 8087Yong-Hing K Kirkaldy-Willis WH: The three joint complex in International Society for the Study of the Lumbar Spine (eds): The Lumbar Spine. Philadelphia: Saunders 1990 pp 80–87

24.

Zdeblick TACooke MEWilson Det al: Anterior cervical discectomy, fusion and plating: a comparative animal study. Spine 18:197419831993Zdeblick TA Cooke ME Wilson D et al: Anterior cervical discectomy fusion and plating: a comparative animal study. Spine 18:1974–1983 1993

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 73 73 25
Full Text Views 70 70 6
PDF Downloads 108 108 6
EPUB Downloads 0 0 0

PubMed

Google Scholar