Techniques for anterior cervical decompression for radiculopathy

Restricted access

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.

Article Information

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

© AANS, except where prohibited by US copyright law.

Headings

References

  • 1

    Abd-Alrahman NDokmak ASAbou-Madawi A: Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir (Wien) 141:108910921999

    • Search Google Scholar
    • Export Citation
  • 2

    Angevine PDArons RRMcCormick PC: National and regional rates and variation of cervical discectomy with and without anterior fusion, 1990–1999. Spine 28:9319402003

    • Search Google Scholar
    • Export Citation
  • 3

    Barlocher CBBarth AKrauss JKBinggeli RSeiler RW: Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus 12:1E42002

    • Search Google Scholar
    • Export Citation
  • 4

    Bertagnoli RYue JJPfeiffer FFenk-Mayer ALawrence JPKershaw T: Early results after ProDisc-C cervical disc replacement. J Neurosurg Spine 2:4034102005

    • Search Google Scholar
    • Export Citation
  • 5

    Bolesta MJRechtine GR IIChrin AM: One- and two-level anterior cervical discectomy and fusion: the effect of plate fixation. Spine J 2:1972032002

    • Search Google Scholar
    • Export Citation
  • 6

    Caspar WGeisler FHPitzen TJohnson TA: Anterior cervical plate stabilization in one- and two-level degenerative disease: overtreatment or benefit?. J Spinal Disord 11:1111998

    • Search Google Scholar
    • Export Citation
  • 7

    Connolly PJEsses SIKostuik JP: Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates. J Spinal Disord 9:2022061996

    • Search Google Scholar
    • Export Citation
  • 8

    Coric DFinger FBoltes P: Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site. J Neurosurg Spine 4:31352006

    • Search Google Scholar
    • Export Citation
  • 9

    Dowd GCWirth FP: Anterior cervical discectomy: is fusion necessary?. J Neurosurg 90:8121999

  • 10

    Goffin JVan Calenbergh Fvan Loon JCasey AKehr PLiebig K: Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine 28:267326782003

    • Search Google Scholar
    • Export Citation
  • 11

    Goldberg GAlbert TJVaccaro ARHilibrand ASAnderson DGWharton N: Short-term comparison of cervical fusion with static and dynamic plating using computerized motion analysis. Spine 32:E371E3752007

    • Search Google Scholar
    • Export Citation
  • 12

    Grob DPeyer JVDvorak J: The use of plate fixation in anterior surgery of the degenerative cervical spine: a comparative prospective clinical study. Eur Spine J 10:4084132001

    • Search Google Scholar
    • Export Citation
  • 13

    Hacker RJ: Cervical disc arthroplasty: a controlled randomized prospective study with intermediate follow-up results. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2005. J Neurosurg Spine 3:4244282005

    • Search Google Scholar
    • Export Citation
  • 14

    Jacobs WCAnderson PGLimbeek JWillems PCPavlov P: Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev 4:CD0049582004

    • Search Google Scholar
    • Export Citation
  • 15

    Kaiser MGHaid RW JrSubach BRBarnes BRodts GE Jr: Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:2292282002

    • Search Google Scholar
    • Export Citation
  • 16

    Lunsford LDBissonette DJJannetta PJSheptak PEZorub DS: Anterior surgery for cervical disc disease. Part 1: treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53:1111980

    • Search Google Scholar
    • Export Citation
  • 17

    McLaughlin MRPurighalla VPizzi FJ: Cost advantages of two-level anterior cervical fusion with rigid internal fixation for radiculopathy and degenerative disease. Surg Neurol 48:5605651997

    • Search Google Scholar
    • Export Citation
  • 18

    Mobbs RJRao PChandran NK: Anterior cervical discectomy and fusion: analysis of surgical outcome with and without plating. J Clin Neurosci 14:6396422007

    • Search Google Scholar
    • Export Citation
  • 19

    Mummaneni PVBurkus JKHaid RWTraynelis VCZdeblick TA: Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6:1982092007

    • Search Google Scholar
    • Export Citation
  • 20

    Murphy MATrimble MBPiedmonte MRKalfas IH: Changes in the cervical foraminal area after anterior discectomy with and without a graft. Neurosurgery 34:93961994

    • Search Google Scholar
    • Export Citation
  • 21

    Nabhan APape DPitzen TSteudel WIBachelier FJung J: Radiographic analysis of fusion progression following one-level cervical fusion with or without plate fixation. Zentralbl Neurochir 68:1331382007

    • Search Google Scholar
    • Export Citation
  • 22

    Oktenoglu TCosar MOzer AFIplikcioglu CSasani MCanbulat N: Anterior cervical microdiscectomy with or without fusion. J Spinal Disord Tech 20:3613682007

    • Search Google Scholar
    • Export Citation
  • 23

    Pickett GERouleau JPDuggal N: Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine 30:194919542005

    • Search Google Scholar
    • Export Citation
  • 24

    Pickett GESekhon LHSears WRDuggal N: Complications with cervical arthroplasty. J Neurosurg Spine 4:981052006

  • 25

    Pimenta LMcAfee PCCappuccino ABellera FPLink HD: Clinical experience with the new artificial cervical PCM (Cervitech) disc. Spine J 4:315S321S2004

    • Search Google Scholar
    • Export Citation
  • 26

    Porchet FMetcalf NH: Clinical outcomes with the Prestige II cervical disc: preliminary results from a prospective randomized clinical trial. Neurosurg Focus 17:3E62004

    • Search Google Scholar
    • Export Citation
  • 27

    Resnick DKTrost GR: Use of ventral plates for cervical arthrodesis. Neurosurgery 60:S112S1172007

  • 28

    Robertson JTPapadopoulos SMTraynelis VC: Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine 3:4174232005

    • Search Google Scholar
    • Export Citation
  • 29

    Samartzis DShen FHLyon CPhillips MGoldberg EJAn HS: Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion?. Spine J 4:6366432004

    • Search Google Scholar
    • Export Citation
  • 30

    Saphier PSArginteanu MSMoore FMSteinberger AACamins MB: Stress-shielding compared with load-sharing anterior cervical plate fixation: a clinical and radiographic prospective analysis of 50 patients. J Neurosurg Spine 6:3913972007

    • Search Google Scholar
    • Export Citation
  • 31

    Savolainen SRinne JHernesniemi J: A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery 43:51551998

    • Search Google Scholar
    • Export Citation
  • 32

    Stulik JPitzen TRChrobok JRuffing SDrumm JSova L: Fusion and failure following anterior cervical plating with dynamic or rigid plates: 6-months results of a multicentric, prospective, randomized, controlled study. Eur Spine J 16:168916942007

    • Search Google Scholar
    • Export Citation
  • 33

    Thorell WCooper JHellbusch LLeibrock L: The long-term clinical outcome of patients undergoing anterior cervical discectomy with and without intervertebral bone graft placement. Neurosurgery 43:2682741998

    • Search Google Scholar
    • Export Citation
  • 34

    Troyanovich SJStroink ARKattner KADornan WAGubina I: Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions. J Spinal Disord Tech 15:69742002

    • Search Google Scholar
    • Export Citation
  • 35

    van Tulder MFurlan ABombardier CBouter L: Updated method guidelines for systematic reviews in the Cochrane collaboration back review group. Spine 28:129012992003

    • Search Google Scholar
    • Export Citation
  • 36

    Wang JCMcDonough PWEndow KKanim LEDelamarter RB: The effect of cervical plating on single-level anterior cervical discectomy and fusion. J Spinal Disord 12:4674711999

    • Search Google Scholar
    • Export Citation
  • 37

    Watters WC IIILevinthal R: Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up. Spine 19:234323471994

    • Search Google Scholar
    • Export Citation
  • 38

    White BDFitzgerald JJ: To graft or not to graft: rationalizing choice in anterior cervical discectomy. Br J Neurosurg 19:1481542005

    • Search Google Scholar
    • Export Citation
  • 39

    Wirth FPDowd GCSanders HFWirth C: Cervical discectomy. A prospective analysis of three operative techniques. Surg Neurol 53:3403482000

    • Search Google Scholar
    • Export Citation
  • 40

    Xie JCHurlbert RJ: Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery 61:1071172007

    • Search Google Scholar
    • Export Citation
  • 41

    Zoëga BKärrholm JLind B: One-level cervical spine fusion. A randomized study, with or without plate fixation, using radiostereometry in 27 patients. Acta Orthop Scand 69:3633681998

    • Search Google Scholar
    • Export Citation
  • 42

    Zoëga BKärrholm JLind B: Outcome scores in degenerative cervical disc surgery. Eur Spine J 9:1371432000

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 587 587 26
Full Text Views 149 149 2
PDF Downloads 186 186 3
EPUB Downloads 0 0 0

PubMed

Google Scholar