title: Smith-Robinson Procedure with an Autologous Iliac Crest for Degenerative Cervical Disc Disease: A 28-Year Follow-Up of 95 Patients.
abstract: BACKGROUND
  Long-term clinical results after anterior cervical discectomy and fusion (ACDF) with an autologous iliac crest are rare. The purpose of this study was to assess this, with special focus on pain, functional outcome, and repeat surgery for adjacent segment disease (ASD).
  
  
  METHODS
  Hospital records of 212 patients who were affected by degenerative cervical disc disease and treated by the Smith-Robinson technique were reviewed. Information about diagnosis, surgery, pre- and postoperative clinical process, and complications was analyzed. Patients were reviewed with a standardized questionnaire including the current neurologic status, Neck Disability Index, EQ-5D, Patient Satisfaction Index, Odom criteria, and limitations in quality of life.
  
  
  RESULTS
  Ninety-five patients with a mean follow-up of 28 years were evaluated. ACDF was performed at 1 level in 67 and 2 levels in 28 patients. Ninety-two patients reported pain before surgery and 68 patients remained pain free and did not require second surgery. At follow-up, the mean Neck Disability Index was 14%, and mean EQ-5D score was 5. Postoperatively, 96.8% of patients were satisfied and 84.2% of patients reported good to excellent functional recovery. One patient had a hairline fracture at the iliac crest donor site. Fourteen patients underwent second surgery because of degenerative changes, including 11 at the symptomatic ASD.
  
  
  CONCLUSIONS
  ACDF yields significant decrease in pain, a significant increase in function, and a high degree of patient satisfaction. Overall prevalence for ASD was 12.0% after 25 years. Patients with reoperation had similar clinical outcome regarding pain, compared with patients without reoperation.
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany. Electronic address: benedikt.burkhardt@uks.eu.
authors.forename: Benedikt W
authors.initials: BW
authors.lastname: Burkhardt
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Brielmaier
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Schwerdtfeger
authors.affiliation: Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
authors.forename: Salman
authors.initials: S
authors.lastname: Sharif
authors.affiliation: Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany.
authors.forename: Joachim M
authors.initials: JM
authors.lastname: Oertel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods*; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: Adjacent segment disease; Anterior cervical discectomy and fusion; Cervical spine; Clinical outcome; Degenerative cervical disc disease; Reoperation