Long-term outcome after anterior cervical discectomy without fusion

Abstract

To retrospectively study the long-term outcome of patients after anterior cervical discectomy without fusion (ACD) compared to results published on the long-term outcome after ACD with fusion (ACDF). We reviewed the charts of all patients receiving ACD surgery between 1985 and 2000 to analyze the direct post-operative results as well as complications of the surgery. Moreover, 102 patients, randomly selected, were interviewed with the neck disability index to study possible persisting complaints up to 18 years after ACD surgery. A total of 551 Patients were identified. Two months post-operative follow up at the outpatient clinic revealed that 90.1% of patients were satisfied with the result of ACD surgery. At the time of the survey, this percentage had dropped to 67.6%. In addition, 20.6% and 11.8% had obtained moderate to severe complaints, respectively, in daily-life activities. Complaints were mainly localized in the neck region and occasionally provoked radiating pain in the arm. On the short term, ACD leads to a satisfied outcome. Over the longer term, patients report increasing complaints. The increase in complaints at the time of the survey may be the result of ongoing degenerative effects. Compared to published data on ACDF, there is no superiority of any fusion technique compared to ACD alone.

Long-term outcomes following anterior foraminotomy for one- or two-level cervical radiculopathy

“…Other than the two patients who required additional operations for adjacent-level disorders, only 3 of 42 patients reported a result worse than G/E (fair in all three cases), a success rate comparable with historical long-term PF data [24][25][26][27] and slightly better than those of ACD [19] or ACDF [12,28,29]. The PF is known to be a highly effective procedure for treatment of patients with cervical radiculopathy and results in long-lasting pain relief and improved quality-oflife outcomes in most patients in terms of motion preservation [27,30].…”

“…In fact, it appears that disc space destruction correlates with spontaneous fusion. ACD leads to spontaneous bony fusion in 70-90 % of cases [17,18] as a result of ongoing degeneration, which is assumed to be related to long-term deterioration of the clinical outcome [19]. Although there is no direct comparison with ACD, AF seems to induce less same-level degeneration, much less spontaneous fusion, and thus less long-term deterioration in the clinical outcome (Fig.…”

Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy

“…Nandoe Tewarie et al 17 also reported recurrence of symptoms in a Class III case series. These authors reported on 456 of 551 patients with cervical radiculopathy who underwent ACD.…”

Comparison of surgical outcomes after anterior cervical discectomy and fusion: does the intra-operative use of a microscope improve surgical outcomes

“…Since the advent of the anterior approach to the cervical spine, several modifications to the surgical technique including refinements made by Cloward in 1958 and Bailey-Badgley in 1960 have been described (1)(2)(3)(4)(5). In 1975, Hankinson and Wilson were the first to describe their experience with the use of the operating microscope for anterior cervical discectomy without fusion (5,6).…”

“…In 1975, Hankinson and Wilson were the first to describe their experience with the use of the operating microscope for anterior cervical discectomy without fusion (5,6). The authors reported their experience with 51 patients undergoing anterior cervical discectomy without fusion and noted superior visualization of surgical anatomy, which facilitated a safer operation and more extensive decompression of neural elements (5). Whether the use of the intra-operative microscope portends a more extensive decompression with fewer intra-operative complications and superior long-term outcomes remains unknown.…”