Mid to Long-term Outcome of Anterior Cervical Discectomy with Fusion

  • M Ali Nouman Senior Registrar Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • M. Mukhtar Khan Postgraduate Resident FCPS–II,Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
Keywords: Cervical spondylosis, myelopathy, anterior cervical discectomy

Abstract

Background: Cervical degenerative conditions such as intervertebral disc prolapse and degenerative cervical spondylosis results in pain and disability, especially in the middle age and elderly. The treatment of choice is surgical decompression once conservative treatment fails. We studied the outcome of anterior cervical decom-pression with instrumented fusion in order to analyse its effectiveness in terms of pain and disability improve-ment. Materials and Methods: This is a retrospective descriptive study. 30 patients were operated during June 2013 and May 2015 (2 years). All patients operated for cervical degenerative conditions were included.Data was collected about neck pain and functional impairment preoperatively using visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) scores. The same scales were used during the follow-period for 6 months. Favourable outcome was defined as 50% reduction in pain and functional improvement to Grade 1 (12 – 15) or normal scores (16 – 17). Results: Mean age was 59.70 years ±8.12SD.Mean preoperative VAS was 6.70 and it was 1.80 ± 0.85 SD at 6 – month follow-up. Mean JOA score was 11.57 preoperatively while at 6-month follow-up, it was 14.97 ± 1.92 SD. There was a significant difference between mean VAS score preoperatively and mean VAS score postoperatively (mean difference; 4.9, 95% CI; 4.48 to 5.32, p < 0.001, t(29): 23.86). Similarly, there was statistically significant difference between mean JOA score preoperatively and mean JOA scores postoperatively (mean difference; -3.4, 95% CI; -3.95 to -2.85, p < 0.001, t(29): -12.61). Conclusion: Anterior cervical decompression with graft placement and instrumented fusion are safe and effective methods for relieving pain as well functional improvement in patients with cervical radiculopathy and myelopathy.
Keywords: , , , , surgical outcome.

References

1. Leonardi M, Boos N. Degenerative disorders of the cer-vical spine. In: Boos N, Aebi M, editors. Spinal disor-ders; Fundamentals of diagnosis and treatment. New York: Springer – Verlag; 2008: p. 429-80.
2. Ahn JS, Lee JK, Kim JH. Comparative study of clinical outcomes of anterior cervical discectomy and fusion using auto-bone graft or cage with bone substitute. Asian Spine J. 2011; 5 (3): 169-75.
3. Hirpara KM, Butler JS, Dolan RT, O'byrne JM, Poyn-ton AR. Non-operative modalities to treat symptomatic cervical spondylosis. Advances in orthopaedics, 2012; 2012: 294857.
4. Burneikiene S, Nelson EL, Mason A, Rajpal S, Villavi-cencio AT. The duration of symptoms and clinical out-comes in patients undergoing anterior cervical discec-tomy and fusion for degenerative disc disease and radi-culopathy. Spine J. 2015; 15 (3): 427-32.
5. Hunt WE, Miller CA. Management of cervical radicu-lopathy. Clin Neurosurg. 1986; 33: 485-502.
6. Robinson Ra, Gw. S. Anterolateral cervical disc remo-val and inter-body fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955; 96: 223–4.
7. Rb C. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958; 15 (6): 602-17.
8. Yao Q, Liang F, Xia Y, Jia C. A meta – analysis com-paring total disc arthroplasty with anterior cervical dis-cectomy and fusion for the treatment of cervical dege-nerative diseases. Arch Orthop Trauma Surg. 2015.
9. Virk SS, Elder JB, Sandhu HS, Khan SN. The cost effe-ctiveness of polyetheretheketone (PEEK) cages for anterior cervical Ddscectomy and fusion. J Spinal Dis-ord Tech. 2015; 28 (8): E482-92.
10. Rodrigo V, Maza A, Calatayud JB, Bances L, Diaz FJ, Gimeno MJ, et al. Long-term follow-up of anterior cer-vical discectomy and fusion with bioabsorbable plates and screws. Clin Neurol Neurosurg. 2015; 136: 116-21.
11. Selvanathan SK, Beagrie C, Thomson S, Corns R, Den-iz K, Derham C, et al. Anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of brachialgia: the Leeds spinal unit experi-ence (2008 – 2013). Acta Neurochir (Wien). 2015; 157 (9): 1595-600.
12. Shriver MF, Lewis DJ, Kshettry VR, Rosenbaum BP, Benzel EC, Mroz TE. Pseudoarthrosis rates in anterior cervical discectomy and fusion: a meta-analysis. Spine J. 2015; 15 (9): 2016-27.
13. Chen BH, Natarajan RN. An HS, Andersson GB. Com-parison of biomechanical response to surgical proce-dures used for cervical radiculopathy: posterior keyhole foraminotomy versus anterior foraminotomy and dis-cectomy versus anterior discectomy with fusion. J Spi-nal Disord. 2001; 14 (1): 17-20.
14. Arts MP, Brand R, Van Den Akker E, Koes BW, Peul WC. The NEtherlands Cervical Kinematics (NECK) Trial. Cost – effectiveness of anterior cervical discec-tomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study. BMC Musculoske-letal Disorders, 2010; 11: 122-.
15. Wang TY, Lubelski D, Abdullah KG, Steinmetz MP, Benzel EC, Mroz TE. Rates of anterior cervical discec-tomy and fusion after initial posterior cervical forami-notomy. Spine J. 2015; 15 (5): 971-6.
16. Vavruch L, Hedlund R, Javid D, Leszniewski W, Sha-labi A. A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the
cervical spine: a clinical and radiologic study. Spine, (Phila Pa 1976). 2002; 27 (16): 1694-701.
17. Abd – Al-Rahman N, Dokmak AS, Abou – Madawi A. Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological out-come study. Acta Neurochir (Wien), 1999; 141 (10): 1089-92.
18. Oktenoglu T, Cosar M, Ozer AF, Iplikcioglu C, Sasani M, Canbulat N, et al. Anterior cervical microdiscec-tomy with or without fusion. J Spinal Disord Tech. 2007; 20 (5): 361-8.
19. Lied B, Roenning PA, Sundseth J, Helseth E. Anterior cervical discectomy with fusion in patients with cervi-cal disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage). BMC Surgery, 2010; 10: 10-.
20. Chesnut RM, Abitbol JJ, Garfin SR. Surgical manage-ment of cervical radiculopathy. Indication, techniques, and results. The Orthopedic clinics of North America, 1992; 23 (3): 461-74.
21. Liu J, Chen X, Liu Z, Long X, Huang S, Shu Y. Ante-rior cervical discectomy and fusion versus corpectomy and fusion in treating two-level adjacent cervical spo-ndylotic myelopathy: a minimum 5 – year follow-up study. Arch Orthop Trauma Surg. 2015; 135 (2): 149-53.
22. Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, et al. Anterior cervi-cal discectomy and fusion associated complications. Spine, (Phila Pa 1976). 2007; 32 (21): 2310-7.
Published
2018-10-03
Section
Original Articles