The Anterior Approach for Removal of Ruptured Cervical Disks

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In the surgical treatment of ruptured lumbar intervertebral disks, the operation of vertebral-body fusion following subtotal removal of the disk with partial laminectomy has been employed since 1943.2 This operation has been performed on over 600 patients and in the writer's experience has proven to be superior to any other operative procedure employed for relief of pain in the back and leg caused by ruptured lumbar disks. The high percentage of permanent cures, the rapid rate of spinal fusion, short period of hospitalization and convalescence, and the early ability of the patient to return to heavy

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Figures

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    (1) Photograph of 6th cervical vertebra with drill and guard superimposed on vertebral body. Note width of drill hole compared to spinal canal (actual size).

    (2) Drawing to show: (a) longus colli muscle retracted from vertebral body, (b) sympathetic chain, (c) drill hole directed diagonally toward (d) unilateral disk protrusion or osteophyte.

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    Case 1. Nurse, aged 46. Pain in neck and shoulder, 8 months. Right brachial neuralgia, 5 months.

    (A) Preoperative roentgenogram. Degenerated disk at C5–6 with posterior osteophytes (arrow).

    (B) Cervical diskogram showing unilateral protrusion of disk (arrow).

    (C) Postoperative film. Disk and marginal osteophytes have been removed and vertebral bodies have been fused. Patient cured.

    (D) Anteroposterior film to demonstrate size and location of bone graft (dowel). In this case it was placed off center for removal of unilateral protrusion of disk.

  • View in gallery

    Instruments used for making the anterior opening into the spinal canal through the intervertebral space, (a) The guard with adjustable screw and lock to vary its length, (b) The twist drill, ½ inch in diameter, (c) Hudson cranial-drill handle.

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    Case 2. Catholic nun, aged 49. “Unbearable” pain at base of neck and shoulders, 3 years.

    (A) Preoperative roentgenogram. Severely degenerated disk (cervical spondylosis) limited to a single joint, C5–6.

    (B) Postoperative film, 2 months after removal of disk and vertebral-body fusion. Pain completely relieved. (This was the first patient operated upon by this method, before technique for removing posterior osteophytes was developed.)

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    Case 3. Doctor's wife, aged 73. Pain in neck, shoulder and arm “for years”. Wore cervical brace 4 years.

    (A) Preoperative roentgenogram. Intraspinal midline disk and osteophyte protrusions C4–5, C5–6 and C6–7 (also verified by myelogram). Anterior subluxation C4 on 5.

    (B) Postoperative film, 5 months following removal of 4th and 5th cervical discs and fusion of both joints. Patient, 85 per cent relieved of pain; cervical brace discarded.

References

1.

BucyP. C.HeimburgerR. F. and OberhillH. R. Compression of the cervical spinal cord by herniated intervertebral discs. J. Neurosurg.19485: 471492.Bucy P. C. Heimburger R. F. and Oberhill H. R. Compression of the cervical spinal cord by herniated intervertebral discs. J. Neurosurg. 1948 5: 471–492.

2.

ClowardR. B. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J. Neurosurg.195310: 154168.Cloward R. B. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications operative technique after care. J. Neurosurg. 1953 10: 154–168.

3.

ClowardR. B. The treatment of ruptured lumbar intervertebral discs. Criteria for spinal fusion. Amer. J. Surg.1953n.s. 86: 145151.Cloward R. B. The treatment of ruptured lumbar intervertebral discs. Criteria for spinal fusion. Amer. J. Surg. 1953 n.s. 86: 145–151.

4.

ClowardR. B. Vertebral body fusion for ruptured lumbar discs. A roentgenographic study. Amer. J. Surg.1955n.s. 90: 969976.Cloward R. B. Vertebral body fusion for ruptured lumbar discs. A roentgenographic study. Amer. J. Surg. 1955 n.s. 90: 969–976.

5.

ClowardR. B. Cervical diskography. Technique, indications and use in diagnosis of ruptured cervical disks. Amer. J. Roentgenol.195879: 563574.Cloward R. B. Cervical diskography. Technique indications and use in diagnosis of ruptured cervical disks. Amer. J. Roentgenol. 1958 79: 563–574.

6.

FrykholmR. Lower cervical vertebrae and intervertebral discs. Surgical anatomy and pathology. Acta chir. scand.1951101: 345359.Frykholm R. Lower cervical vertebrae and intervertebral discs. Surgical anatomy and pathology. Acta chir. scand. 1951 101: 345–359.

7.

MayfieldF. H. Cervical trauma. Neurosurgical aspects. Proc. Congr. neurol. Surg.19552: 83100.Mayfield F. H. Cervical trauma. Neurosurgical aspects. Proc. Congr. neurol. Surg. 1955 2: 83–100.

8.

WalkerE. Personal communication.Walker E. Personal communication.

9.

WiltbergerB. R. The prefit dowel intervertebral body fusion as used in lumbar disc therapy. A preliminary report. Amer. J. Surg.1953n.s. 86: 723727.Wiltberger B. R. The prefit dowel intervertebral body fusion as used in lumbar disc therapy. A preliminary report. Amer. J. Surg. 1953 n.s. 86: 723–727.

10.

YuhlE. T.HannaD.RasmussenT. and RichterR. B. Diagnosis and surgical therapy of chronic midline cervical disk protrusions. Neurology19555: 494509.Yuhl E. T. Hanna D. Rasmussen T. and Richter R. B. Diagnosis and surgical therapy of chronic midline cervical disk protrusions. Neurology 1955 5: 494–509.

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