Elsevier

Surgical Neurology

Volume 53, Issue 4, April 2000, Pages 340-348
Surgical Neurology

Spine
Cervical discectomy: A prospective analysis of three operative techniques

https://doi.org/10.1016/S0090-3019(00)00201-9Get rights and content

Abstract

BACKGROUND

Cervical disc herniation causing neurological compromise is a common affliction. Sophisticated surgical treatments have been developed throughout the twentieth century and are largely successful. Although each procedure has its supporters, it is still unclear if one surgical technique is superior.

METHODS

A prospective trial was designed to evaluate the efficacy of three surgical procedures for the treatment of cervical radiculopathy caused by a unilateral acute herniated cervical disc. Patients were randomized to posterior cervical foraminotomy (FOR), and anterior cervical discectomy with (ACDF), and without (ACD) fusion. Perioperative data, office follow-up and long-term follow-up were used to compare the procedures.

RESULTS

All of the procedures yielded excellent relief of symptoms and signs postoperatively and during follow-up. Operative time and hospital stay were slightly shorter for ACD compared with ACDF and FOR. Reoperations occurred in all groups but there was a trend for higher recurrence at the same level with FOR and recurrence at other levels with ACDF.

CONCLUSION

All three of the procedures were successful for treatment of cervical radiculopathy caused by a herniated cervical disc. Although the numbers in this study were small, none of the procedures could be considered superior to the others. This study suggests that the selection of surgical procedure may reasonably be based on the preference of the surgeon and tailored to the individual patient.

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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