Extended anterior cervical discectomy without fusion: a simple and sufficient operation for most cases of cervical degenerative disease.
Of 291 operations performed for cervical degenerative disease causing cord or root involvement over a 12-year period 187 have been treated by extended anterior discectomy without fusion, removing bone on either side of the posterior disc space so as to give a wide exposure of the anterior spinal and root dura. The technique has been used for 73% of the cases operated on in the last four years. Nine patients (4.8%) required an additional posterior decompression for coexisting spinal or root canal stenosis. By the first postoperative follow-up at 2-4 months 94.5% of patients showed clear neurological or functional improvement, 3% were worse and 1.5% had died (the deaths were in elderly patients with severe myelopathy and intercurrent disease). Minor treatable complications occurred in 3.2%. Only two patients (1%) complained of persistent postoperative neck pain. Patients were mobilized immediately after surgery without a collar and most left hospital within 1-4 days. A single level decompression was sufficient in 92% of patients and only one patient required more than two levels to be decompressed. In 79% of cases soft disc protrusions contributed to the compression while in 21% osteophytes alone caused the compression. We believe that this simple technique is a sufficient surgical treatment for the majority of cases of cervical degenerative disease. It does not require a fusion and avoids the specific problems and complications associated with Cloward type operations. We are engaged at present in a long-term follow up study of these patients, but to date no late problems have become apparent.
Maurice-Williams
R S
RS
Department of Neurosurgery, Royal Free Hospital and School of Medicine, London, UK.
Dorward
N L
NL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009192:Myelography; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000601:surgery; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis; D012086:Reoperation; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D013126:Spinal Nerve Roots / Q000473:pathology / Q000601:surgery; D013128:Spinal Osteophytosis / Q000175:diagnosis / Q000601:surgery*; D013130:Spinal Stenosis / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome