title: The choice of the best surgery after single level anterior cervical spine discectomy: a systematic review.
abstract: BACKGROUND
  The anterior cervical discectomy (ACD) is often used to treat spinal cord and nerve root compressions and the frequent use of interbody fusion (ACDF) has popularized it as a common practice associated or not with cages or plates for maintaining the intervertebral disc height.
  
  
  OBJECTIVE
  The aim of this study is to clarify the effectiveness of ACD compared with ACDF, with or without the use of anterior cervical spacer (Cage) or instrumentation with plate fixation (ACDFI).
  
  
  METHODS
  randomized controlled trials or quasi-randomized trials were selected for analysis in one segmental level. The comparison criteria were the rates of success and failure with surgery (Odom's' criteria), fusion rates and kyphosis rates. Electronic search was made in the MEDLINE database (Pubmed), in the Central Registry of randomized trials of Cochrane database and EMBASE.
  
  
  RESULTS
  Seven studies were selected for analysis.
  
  
  CONCLUSIONS
  
  
  
  CONCLUSIONS
  There is moderate evidence that clinical results of ACD and ACDF are not significant different. There is moderate evidence that addition of intervertebral cage enhance clinical results.There is moderate evidence that anterior cervical plate does not change the clinical results of ACD. There is moderate evidence that ACD produce more segmental kyphosis than ACDF and ACDFI, with use of cage or plate.There is moderate evidence that ACD produce lower rate of fusion than ACDF and than the cages. There is limited evidence of the lower capacity of PMMA to produce fusion. There is limited evidence that fused patients have better outcome than non fused patients.
authors.affiliation: Spine surgery Service-Hospital do Servidor Público do Estado de São Paulo-São Paulo, Brazil.
authors.forename: Ricardo Vieira
authors.initials: RV
authors.lastname: Botelho
authors.forename: Yuri
authors.initials: Y
authors.lastname: Dos Santos Buscariolli
authors.forename: Marcus Vinicius Flores
authors.initials: MV
authors.lastname: de Barros Vasconcelos Fernandes Serra
authors.forename: Marcia Nogueira Pires
authors.initials: MN
authors.lastname: Bellini
authors.forename: Wanderley Marques
authors.initials: WM
authors.lastname: Bernardo