Anterior cervical discectomy

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Anterior cervical discectomy

The most common surgical techniques are cervical discectomy with or without fusing the two adjacent intervertebral bodies. Robinson and Smith 1) 2) 3) 4). introduced the anterior cervical decompression technique without microscope, but with fusion by inserting a bone graft harvested from the iliac crest of the patient.

Hankinson and Wilson 5) improved the procedure with the use of an operating microscope; however, they performed the surgery without leaving a graft behind; the results of both types of surgery were entirely comparable 6) 7) 8).

In time several modifications of these surgical techniques have been made 9) 10) 11).

Anterior

Surgical decompression for cervical radiculopathy includes:

1.- Anterior cervical discectomy without any prosthesis or fusion: rarely used today.

2.- Anterior cervical discectomy and fusion with interbody fusion: the most common approach.

a.- without anterior cervical plate.

b.- with anterior cervical plate or with zero profile.

3.- with artificial disc: see Cervical disc arthroplasty

4.- Percutaneous

a.- Anterior percutaneous cervical disc chemonucleolysis.

Tissue trauma is significantly reduced with laser and endoscopic surgery techniques. Anterior cervical laser discectomy and Anterior percutaneous endoscopic cervical discectomy are both suitable for the specific indication of soft, symptomatic contained cervical disc herniations. A prospective cohort study indicates that Anterior cervical laser discectomy and Anterior percutaneous endoscopic cervical discectomy are options for cervical decompression surgery when medical comorbidities or preferences by patients and surgeons dictate more minimally invasive strategies 12).

Technique

see Anterior cervical discectomy technique

Complications

see Anterior cervical discectomy complications.

Outcome

see Anterior cervical discectomy outcome.

Case series

see Anterior cervical discectomy case series.

References

1)

Aronson N, Filtzer Dl, Bugan M. Anterior cervical fusion by the Smith–Robinson approach. J Neurosurg. 1968;29:397–404.
2)

Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull John Hopkins Hosp. 1955;96(Suppl):223–224.
3)

Robinson RA. Anterior and posterior cervical spine fusions. Clin Orthop Relat Res. 1964 Jul-Aug;35:34-62. PubMed PMID: 5889170.
4)

SMITH GW, ROBINSON RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958 Jun;40-A(3):607-24. PubMed PMID: 13539086.
5)

Hankinson HL, Wilson CB. Use of the operating microscope in anterior cervical discectomy without fusion. J Neurosurg. 1975 Oct;43(4):452-6. PubMed PMID: 1159482.
6)

Abd-Alrahman N, Dokmak AS, Abou-Madawi A. Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir (Wien). 1999;141(10):1089-92. PubMed PMID: 10550654.
7)

Dowd GC, Wirth FP. Anterior cervical discectomy: is fusion necessary? J Neurosurg. 1999 Jan;90(1 Suppl):8-12. PubMed PMID: 10413119.
8)

Jacobs WC, Anderson PG, Limbeek J, Willems PC, Pavlov P. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004958. Review. Update in: Cochrane Database Syst Rev. 2011;(1):CD004958. PubMed PMID: 15495130.
9)

Baskin DS, Ryan P, Sonntag V, Westmark R, Widmayer MA. A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogenetic protein-2 with the CORNERSTONE-SR allograft ring and the ATLANTIS anterior cervical plate. Spine (Phila Pa 1976). 2003 Jun 15;28(12):1219-24; discussion 1225. PubMed PMID: 12811263.
10)

CLOWARD RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958 Nov;15(6):602-17. PubMed PMID: 13599052.
11)

Madawi AA, Powell M, Crockard HA. Biocompatible osteoconductive polymer versus iliac graft. A prospective comparative study for the evaluation of fusion pattern after anterior cervical discectomy. Spine (Phila Pa 1976). 1996 Sep 15;21(18):2123-9; discussion 2129-30. PubMed PMID: 8893437.
12)

Hellinger S, Knight M, Telfeian AE, Lewandrowski KU. Patient selection criteria for percutaneous anterior cervical laser versus endoscopic discectomy. Lasers Surg Med. 2022 Jan 6. doi: 10.1002/lsm.23514. Epub ahead of print. PMID: 34989414.

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