Surgical planning and neurological outcome after anterior approach to remove a disc herniation at the C7-T1 level in 19 patients.
METHODS
Retrospective cohort study.


OBJECTIVE
The purpose of this study was to report the neurological presentation, outcome and surgical planning in a series of patients with a symptomatic single-level C7-T1 disc herniation who underwent anterior surgical discectomy and fusion.


BACKGROUND
Disc herniations at C7-T1 are uncommon, and there are few large series in the literature describing anterior treatment of such herniations.


METHODS
We performed a retrospective study of patients who underwent surgery for a C7-T1 disc herniation and reviewed the medical records, operative reports, and imaging studies. The surgeons' view line was drawn and its relation to the manubrium and the great vessels was determined on T1 sagittal magnetic resonance imaging. The location of the herniated disc in the spinal canal was determined using a T2 axial magnetic resonance imaging and classified as central, foraminal, and central/foraminal. Loss of muscle strength was evaluated preoperatively and at the last follow-up according to the classification of the Medical Research Council. The disc space was approached anteriorly by a standard cervical supramanubrial Smith-Robinson approach.


RESULTS
We identified 19 patients who had undergone C7-T1 discectomy and fusion. The mean age of the sample was 54.26 ± 8.65 years. There was a higher proportion of male patients (57.9%, 11/19). The clinical presentation was predominantly motor deficit in 15/19 cases (78.9%) in intrinsic hand muscles, and usually improved after surgery. The mean follow-up period was 27.05 ± 15.10 months. All the patients underwent an anterior cervical supramanubrial approach with microdiscectomy and fusion. Anterior cervical plate fixation was used in 9/19 cases (47.3%). In the rest of the cases, a stand-alone intervertebral device was placed.


CONCLUSIONS
An anterior cervical supramanubrial approach was easily accomplished in all patients. Motor deficit was the most common surgical indication.


METHODS
4.
*Medical School of the University of Caxias do Sul, Caxias do Sul, RS, Brazil †University of Caxias do Sul, Caxias do Sul, RS, Brazil ‡Instituto de Rehabilitación Psicofisica, Buenos Aires, Argentina §Hospital Universitario San Jorge (HUSJ), Pereira, Risaralda, Colombia ¶Rio de Janeiro State University and the Fernando Pereira da Silva Public Hospital, Macaé, RJ, Brazil ‖Hospital São Lucas da PUCRS, Porto Alegre, RS, Brazil **University of Caxias do Sul, Caxias do Sul, RS, Brazil; and ††Washington University School of Medicine, Washington, Saint Louis, MO.
Asdrubal
A
Falavigna
Orlando
O
Righesso
Alejandro
A
Betemps
Pablo Fernando
PF
Vela de los Rios
Rangel
R
Guimarães
Marcus
M
Ziegler
Olivia Egger
OE
de Souza
Pedro Guarise
PG
da Silva
Daniel K
DK
Riew
D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome