Single level anterior cervical discectomy without fusion: An outcome analysis

Introduction: From the beginning several surgical techniques have been invented to treat herniated cervical intervertebral disc. Long term results with well-designed studies have not been evaluated. Variation in Surgical Technique: The surgical techniques have varied with several variable factors and different variables used for evaluation. Postoperative interscapular pain following ACD has varied from 4–100%. The occupation status has been evaluated with Odom’s criteria and has varied significantly in different series. Factors like ASD, fusion, foraminal height have also varied and complications have varied from 0–18% the commonest being transient hoarseness and interscapular pain. Minimally Invasive ACD: Chymopapain, laser, RF or nucleoplasty have been used. They are useful only in selected cases. Endoscopic decompression is becoming popular. Microscopic anterior or posterior foraminotomy is also useful. Conclusion: ACD is a useful procedure and there is no significant difference in long term outcome between ACD and ACDF, following single level cervical disc herniation. Received: 31-01-11; Revised: ; Accepted: Disclosures: This article has not received any funding and has no vested commercial interest Acknowledgements: None 06-06-11 15-11-11 nBackground The optimal approach for decompression of the spinal cord and nerve roots in the cervical region is still controversial, and both anterior and posterior approaches are reported to 1–4 give good clinical outcomes. The posterior approach was initially described in 1934 by Mixter and Barr, who performed cervical laminectomy to treat cervical degenerative disease. Posterior cervical foraminotomy with or without discectomy is another method proposed to treat a subgroup of patients suffering 5 from cervical degenerative pathologies. 6–8 From the late 1950s, Smith and Robinson (1955) and 9 Cloward (1958) introduced the alternative approach of anterior transdiscal excision combined with an interbody graft insertion for treating myeloradiculopathies secondary to disc herniation and spondylosis in the cervical region. The efficacy and simplicity of this approach has popularized it during the last four decades as a widely used method to surgically treat cervical disc herniation. Some concerns regarding the complications associated with autologous graft harvesting, collapse or anterior or posterior dislodgement of the grafted material causing spinal cord compression or dysphagia, excision of a part of the vertebral body and replacing it with a non-vital tissue and increased cost and duration of hospitalization, led to the adoption of discectomies and graftless fusion techniques, which is frequently entitled “anterior cervical discectomy without fusion (ACD)”. Shortly, after introducing the anterior approach for cervical discectomy, Hirsch debated the necessity of interbody fusion proposing anterior subtotal removal of cervical disc material omitting 862 n n n J. Spinal Surg. Vol. 4 No. 1 July 2012 n n nJ. Spinal Surg. Vol. 4 No. 1 July 2012 nReferences 1. Baskin DS, Ryan P, Sonntag V, Westmark R, Widmayer MA. 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