Object The need for interbody fusion or stabilization after anterior cervical microdiscectomy is still debated. The objectives of this prospective randomized study were 1) to examine whether combined interbody fusion and stabilization is more beneficial than microdiscectomy only (MDO) and 2) if fusion is found to be more beneficial than MDO, to determine which is the best method of fusion by comparing the results achieved using autologous bone graft (ABG), polymethylmethacrylate (PMMA) interposition, and threaded titanium cage (TTC). Methods A total of 125 patients with a single-level cervical disc disease were included in this prospective study. All patients were randomized and assigned to one of the four following groups: Group 1 (33 patients), MDO; Group 2 (30 patients), microdiscectomy followed by ABG; Group 3 (26 patients), microdiscectomy followed by injection of PMMA; and Group 4 (36 patients), microdiscectomy followed by placement of a TTC. Clinical outcome according to Odom criteria was summarized as 1) excellent and good or 2) satisfactory and poor. One-year follow-up examination was performed in 123 patients. Patients in the TTC group experienced a significantly better outcome 6 months after surgery (92% excellent and good results) compared with those in the MDO and ABG groups (72.7 and 66.6% excellent and good results, respectively). Twelve months after surgery there was still a significant difference in outcomes between the TTC group (94.4% excellent and good results) and the MDO group (75.5% excellent and good results). Outcome in patients treated with PMMA was comparable with that in those treated with TCC after 6 (91.6%) and 12 months (87.5%), but no segmental fusion was achieved. Differences compared with MDO and ABG were, however, not significant, which may be related to the smaller number of patients in the PMMA group. Conclusions Interbody cage-assisted fusion yields a significantly better short- and intermediate-term outcome than MDO in terms of return to work, radicular pain, Odom criteria, and earlier fusion. In addition, the advantages of interbody cages over ABG fusion included better results in terms of return to work, Odom criteria, and earlier fusion after 6 months. These results suggest that interbody cage–assisted fusion is a promising therapeutic option in patients with single-level disc disease. Polymethylmethacrylate seems to be a good alternative to interbody cage fusion but is hindered by the absence of immediate fusion.

Object. The authors conducted a prospective study to investigate the efficacy of kryorhizotomy, an alternative procedure for lumbar medial branch neurotomy, in the treatment of lumbar facet syndrome (LFS). Methods. Fifty patients with chronic low-back pain, in whom pain was relieved by controlled diagnostic medial branch blocks of the lumbar zygapophyseal (facet) joints, underwent lumbar medial branch kryorhizotomy. Outcome was evaluated using the Visual Analog Pain Scales and assessment of work capacity. All outcome measures were repeated at 6 weeks, 6 months, and 1 year after surgery. At 1-year follow-up examination, 31 (62%) of 50 patients experienced a good response to lumbar facet kryorhizotomy. Good results with pain relief of 50% or more were obtained in 85% of patients without previous spinal surgery but only in 46% who had undergone previous spinal surgery. This difference was statistically significant. In five patients (16%) in whom a good initial benefit was observed but who experienced increased pain within 6 weeks after kryorhizotomy, the beneficial result was regained after an early repeated procedure. There were no side effects. Overall, 19 (38%) of 50 procedures were not considered successful. In six of these 19 cases a rigid stabilization of the involved segment provided permanent pain relief. Conclusions. Based on this study, patients with LFS who have not undergone previous spinal surgery benefit significantly from percutaneous lumbar kryorhizotomy. Kryorhizotomy, which has virtually no risk, seems to be a valuable alternative technique to lumbar medial branch neurotomy.

Postoperative outcome of central lumbar disc herniation (CLDH) is poorer as compared with other types of lumbar disc herniation. The reason seems to be the anatomical position of the disc herniation with a peculiar derangement of the disc architecture. The surgical approach itself or the subcategories of CLDH appear to have only minor impact on postoperative outcome. Interlaminar fenestrations, in general, are appropriate for removal of the disc fragments.

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