SpineCervical discectomy: A prospective analysis of three operative techniques
Section snippets
Patient population
A randomized, prospective study of patients presenting with cervical radiculopathy caused by a unilateral herniated cervical disc was designed to evaluate the surgical treatment methods. The patient accrual was from 1984 until 1991, inclusive. All patients had single-level disease. Exclusion criteria were signs of myelopathy and additional degenerative changes on plain radiography. Patients with cervical spondylosis were evaluated concurrently and the results are reported elsewhere.
Results
The demographic analysis (Table 1) indicates that the populations undergoing each of the procedures were similar with respect to age (FOR: 43.8, ACD: 45.0, ACDF: 41.7 years), gender (Female; FOR: 59%, ACD: 48%, ACDF: 44%), smoking history (FOR: 41%, ACD: 60%, ACDF: 60%), accidents (FOR: 5%, ACD: 8%, ACDF: 8%), incidence of compensation claims (FOR: 14%, ACD: 16%, ACDF: 8%), and duration of symptoms (FOR: 5.5, ACD: 7.3, ACDF: 4.0 weeks). The preoperative neurological findings between groups are
Discussion
There are many variables to consider regarding the decision to approach the herniated cervical disc via the anterior or posterior route. These depend on patient factors, technical differences between procedures, and surgeon experience and preference.
The majority of the pathology that may affect a nerve root is situated anteriorly: disc herniation and osteophyte formation [14]. It is logical to approach these structures with an anterior cervical discectomy (ACD). Although rare, complications
Conclusion
This prospective, randomized study compared the three procedures commonly utilized for the surgical treatment of cervical radiculopathy caused by a unilateral herniated nucleus pulposus. All three yielded excellent relief of subjective symptoms and objective signs of this condition. There was a trend toward reduced operative time and hospital stay and reduced reoperations with the ACD technique. However, all of the procedures were efficacious and may be reasonably employed based on the
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