Anterior cervical discectomy with and without interbody bone graft

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✓Fifty-one patients with symptomatic cervical disc disease refractory to conservative management were allocated at random to one of two treatment groups. The standard anterior approach devised by Cloward was used for 25 patients, and radical discectomy and foraminotomy for the other 26. All patients were followed for 6 months or longer with interview, physical examination, and radiographic evaluation. There was no difference in the success rate between the two groups. The large majority (92%) of patients in both groups were pleased with results of their operation. Because of technical factors related to operative exposure of the spinal canal and nerve roots, we prefer the Cloward procedure for patients symptomatic from advanced spondylosis and reserve discectomy without bone graft insertion for those with minimal spondylosis or soft disc herniations.

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Address reprint requests to: Col. Albert N. Martins, Neurosurgery Service, Walter Reed Army Medical Center, Washington, D.C. 20012.

© AANS, except where prohibited by US copyright law.

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    Radical discectomy without interbody bone graft. Upper Left: A window is cut into the anterior longitudinal ligament from one joint of Luschka to the other. Center & Lower Left: Entire contents of disc space are removed including cartilaginous plates. Vertebral body spreader improves exposure. Upper Right: Through the incised posterior longitudinal ligament, posterior osteophytes are removed laterally as well as medially with curettes and bone punches. Lower Right: At end of procedure, anterior osteophytes determine the extent of angulation, which usually diminishes with time.

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    Radiographs of a 32-year-old man with discectomy at C5–6 for soft disc herniation. Left to Right: Preoperative film, and at 1 day, 6 weeks, and 6 months postoperatively. Observe the improvement in alignment with time, the bone-bridging at 6 months and remodeling of the vertebral bodies where they touch anteriorly.

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    Radiograph of a 54-year-old man with discectomy at C5–6 and C6–7 for cervical spondylosis with radiculopathy. Observe the excellent alignment, and little evidence of bone bridging the discectomy sites (no motion on flexion-extension radiographs).

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    Radiographs of a 48-year-old woman with discectomy at C6–7 for acute soft disc herniation. Left: At 1 week postoperatively. Right: At 21 months postoperatively. Observe the solid body union in good alignment.

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