Anterior cervical discectomy and fusion: Surgical indications and outcomes
Introduction
Cervical spondylosis and disk herniation are common problems that can lead to radiculopathy and myelopathy from progressive foraminal or central stenosis. Although the majority of symptomatic patients will improve with conservative therapy, some will have persistent or worsening symptoms that require surgery. Multiple surgical procedures have been developed to treat cervical radiculopathy. Anterior cervical discectomy and fusion (ACDF) was first described by Robinson and Cloward and has now become the most commonly performed procedure for symptomatic cervical disc herniations yielding a long track record of outstanding outcomes.1, 2
Section snippets
Indications
Neural element compression can occur from soft disc herniation (Fig. 1) or osteophyte formation in the setting of spondylosis (“hard disc” herniation, Fig. 2). Frequently these affect the foraminal region, leading to upper extremity radiculopathy. With more midline or paracentral herniations, less well-defined radicular symptoms may be seen or even myelopathy symptoms due to direct cord compression.
The most commonly accepted surgical indications for ACDF include (1) persistent or recurrent arm
Outcomes
Robinson et al.2 published the first large series of ACDF patients in 1962 with poor results in only 6% of the patients. More recent studies have reported even better results, especially for single-level fusions.3, 4 Looking at SF-36 outcomes, comparable improvements are seen following ACDF to that of total hip and knee replacements.5 Yue et al. investigated the durability of ACDF with 5–11-year follow-up from allograft plating with over 95% of patients reporting continued improvement in neck
Summary
Performed on appropriately selected patients, ACDF is a highly reliable surgical procedure for the symptomatic disc herniations that have failed conservative treatment. Both direct and indirect decompression of bilateral neural elements can be achieved, producing excellent results. The risk of nonunion increases with multi-level procedures, but can be minimized by utilizing a plate and encouraging smoking cessation.
References (27)
- et al.
Effects of nicotine on cellular function in UMR 106-01 osteoblast-like cells
Bone
(1991) - et al.
Alteration of load sharing of anterior cervical implants with change in cervical sagittal alignment
Med Eng Phys
(2008) The anterior approach for removal of ruptured cervical disks
J Neurosurg
(1958)- et al.
The results of anterior interbody fusion of the cervical spine
J Bone Joint Surg Am
(1962) - et al.
The effect of cervical plating on single-level anterior cervical discectomy and fusion
J Spinal Disord
(1999) - et al.
Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study
Spine
(2005) - et al.
Comparison of short-term SF-36 results between total joint arthroplasty and cervical spine decompression and fusion or arthroplasty
Spine
(2009) - et al.
The revision rate and occurrence of adjacent segment disease after anterior cervical discectomy and fusion: a study of 672 consecutive patients
Spine
(2014) - et al.
Anterior cervical pseudarthrosis. Natural history and treatment
Spine
(1997) - et al.
Anterior cervical discectomy and fusion without instrumentation
Spine
(2007)