Abstract
Purpose
Cervical disc herniation is a common pathology. It can be treated by different surgical procedures. We aimed to list and analyzed every available surgical option. We focused on the comparison between anterior cervical decompression and fusion and cervical disc arthroplasty.
Results
The anterior approach is the most commonly used to achieve decompression and fusion by the mean of autograft or cage that could also be combined with anterior plating. Anterior procedures without fusion have shown good outcomes but are limited by post-operative cervicalgia and kyphotic events. Posterior cervical foraminotomy achieved good outcomes but is not appropriate in a case of a central hernia or ossification of the posterior ligament. Cervical disc arthroplasty is described to decrease the rate of adjacent segment degeneration. It became very popular during the last decades with numerous studies with different implant device showing encouraging results but it has not proved its superiority to anterior cervical decompression and fusion. Anterior bone loss and heterotopic ossification are still to be investigated.
Conclusion
Anterior cervical decompression and fusion remain the gold standard for surgical treatment of cervical disc herniation.
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References
Yamano Y (1985) Soft disc herniation of the cervical spine. Int Orthop 9:19–27. https://doi.org/10.1007/BF00267033
Herkowitz HN, Kurz LT, Overholt DP (1990) Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine 15:1026–1030
Liao J-C, Niu C-C, Chen W-J, Chen L-H (2008) Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion. Int Orthop 32:643–648. https://doi.org/10.1007/s00264-007-0378-x
Xie Y, Li H, Yuan J et al (2015) A prospective randomized comparison of PEEK cage containing calcium sulphate or demineralized bone matrix with autograft in anterior cervical interbody fusion. Int Orthop 39:1129–1136. https://doi.org/10.1007/s00264-014-2610-9
SMITH GW, ROBINSON RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40–A:607–624. https://doi.org/10.2106/00004623-195840030-00009
Ipsen BJ, Kim DH, Jenis LG et al (2007) Effect of plate position on clinical outcome after anterior cervical spine surgery. Spine J Off J North Am Spine Soc 7:637–642. https://doi.org/10.1016/j.spinee.2006.09.003
Chin KR, Pencle FJR, Mustafa LS et al (2018) Sentinel sign in standalone anterior cervical fusion: outcomes and fusion rate. J Orthop 15:935–939. https://doi.org/10.1016/j.jor.2018.08.027
Spallone A, Marchione P, Li Voti P et al (2014) Anterior cervical discectomy and fusion with “mini-invasive” harvesting of iliac crest graft versus polyetheretherketone (PEEK) cages: a retrospective outcome analysis. Int J Surg 12:1328–1332. https://doi.org/10.1016/j.ijsu.2014.11.003
Pointillart V, Cernier A, Vital JM, Senegas J (1995) Anterior discectomy without interbody fusion for cervical disc herniation. Eur Spine J 4:45–51
Ruetten S, Komp M, Merk H, Godolias G (2007) A new full-endoscopic technique for cervical posterior Foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients. Minim Invasive Neurosurg 50:219–226. https://doi.org/10.1055/s-2007-985860
Reitz H, Joubert MJ (1964) Intractable headache and cervico-brachialgia treated by complete replacement of cervical intervertebral discs with a metal prosthesis. South Afr Med J Suid-Afr Tydskr Vir Geneeskd 38:881–884
Cheng L, Nie L, Zhang L, Hou Y (2008) Fusion versus Bryan cervical disc in two-level cervical disc disease: a prospective, randomised study. Int Orthop 33:1347. https://doi.org/10.1007/s00264-008-0655-3
Bertagnoli R, Yue JJ, Pfeiffer F et al (2005) Early results after ProDisc-C cervical disc replacement. J Neurosurg Spine 2:403–410. https://doi.org/10.3171/spi.2005.2.4.0403
Kieser DC, Cawley DT, Fujishiro T et al (2018) Risk factors for anterior bone loss in cervical disc arthroplasty. J Neurosurg Spine 29:123–129. https://doi.org/10.3171/2018.1.SPINE171018
Luo J, Gong M, Huang S et al (2015) Incidence of adjacent segment degeneration in cervical disc arthroplasty versus anterior cervical decompression and fusion meta-analysis of prospective studies. Arch Orthop Trauma Surg 135:155–160. https://doi.org/10.1007/s00402-014-2125-2
Scoville WB (1945) Recent developments in the diagnosis and treatment of cervical ruptured intervertebral discs. Proc Am Fed Clin Res 2:23
Song Z, Zhang Z, Hao J et al (2016) Microsurgery or open cervical foraminotomy for cervical radiculopathy? A systematic review. Int Orthop 40:1335–1343. https://doi.org/10.1007/s00264-016-3193-4
O’Toole JE, Sheikh H, Eichholz KM et al (2006) Endoscopic posterior cervical foraminotomy and discectomy. Neurosurg Clin N Am 17:411–422. https://doi.org/10.1016/j.nec.2006.06.002
Gala VC, O’Toole JE, Voyadzis J-M, Fessler RG (2007) Posterior minimally invasive approaches for the cervical spine. Orthop Clin N Am 38:339–349. https://doi.org/10.1016/j.ocl.2007.02.009
Hosono N, Yonenobu K, Ono K (1996) Neck and shoulder pain after laminoplasty. A noticeable complication. Spine 21:1969–1973
Zdeblick TA, Zou D, Warden KE et al (1992) Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg Am 74:22–27
Epstein NE, Schwall G, Reillly T et al (2011) Surgeon choices, and the choice of surgeons, affect total hospital charges for single-level anterior cervical surgery. Spine 36:905–909. https://doi.org/10.1097/BRS.0b013e3181e6c4d8
Topuz K, Çolak A, Kaya S et al (2009) Two-level contiguous cervical disc disease treated with peek cages packed with demineralized bone matrix: results of 3-year follow-up. Eur Spine J 18:238–243. https://doi.org/10.1007/s00586-008-0869-5
Dickerman RD, Reynolds AS, Morgan B (2008) Polyetheretherketone (PEEK) cage filled with bone morphogenic protein and demineralised bone matrix in anterior cervical discectomy and fusion. Int Orthop 32:717–717. https://doi.org/10.1007/s00264-007-0450-6
Young WF, Rosenwasser RH (1993) An early comparative analysis of the use of fibular allograft versus autologous iliac crest graft for interbody fusion after anterior cervical discectomy. Spine 18:1123–1124
Park J-B, Cho Y-S, Riew KD (2005) Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Jt Surg 87:558–563. https://doi.org/10.2106/JBJS.C.01555
Wang JC, McDonough PW, Kanim LE et al (2001) Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion. Spine 26:643–646-647
Das K, Couldwell WT, Sava G, Taddonio RF (2001) Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note. J Neurosurg 94:174–178
Fraser JF, Härtl R (2007) Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 6:298–303. https://doi.org/10.3171/spi.2007.6.4.2
Suk K-S, Kim K-T, Lee S-H, Park S-W (2006) Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop 30:290–294. https://doi.org/10.1007/s00264-005-0072-9
Zhou J, Li J, Lin H et al (2018) A comparison of a self-locking stand-alone cage and anterior cervical plate for ACDF: minimum 3-year assessment of radiographic and clinical outcomes. Clin Neurol Neurosurg 170:73–78. https://doi.org/10.1016/j.clineuro.2018.04.033
Kapetanakis S, Thomaidis T, Charitoudis G et al (2017) Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life. J Spine Surg 3:312–322. https://doi.org/10.21037/jss.2017.06.21
Grasso G, Giambartino F, Tomasello G, Iacopino G (2014) Anterior cervical discectomy and fusion with ROI-C peek cage: cervical alignment and patient outcomes. Eur Spine J 23:650–657. https://doi.org/10.1007/s00586-014-3553-y
Grasso G, Landi A (2018) Long-term clinical and radiological outcomes following anterior cervical discectomy and fusion by zero-profile anchored cage. J Craniovertebral Junction Spine 9:87–92. https://doi.org/10.4103/jcvjs.JCVJS_36_18
Chen Y, Lü G, Wang B et al (2016) A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study with 2-year follow-up. Eur Spine J 25:2255–2262. https://doi.org/10.1007/s00586-016-4391-x
Fountas KN, Kapsalaki EZ, Nikolakakos LG et al (2007) Anterior cervical discectomy and fusion associated complications. Spine 32:2310–2317. https://doi.org/10.1097/BRS.0b013e318154c57e
Jho HD (1996) Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation. J Neurosurg 84:155–160. https://doi.org/10.3171/jns.1996.84.2.0155
Ahn Y, Lee SH, Chung SE et al (2005) Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation. Neuroradiology 47:924–930. https://doi.org/10.1007/s00234-005-1436-y
Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop 33:1677. https://doi.org/10.1007/s00264-008-0684-y
Fernström U (1966) Arthroplasty with intercorporal endoprothesis in herniated disc and in painful disc. Acta Chir Scand Suppl 357:154–159
Pointillart V, Castelain J-E, Coudert P et al (2018) Outcomes of the Bryan cervical disc replacement: fifteen year follow-up. Int Orthop 42:851–857. https://doi.org/10.1007/s00264-017-3745-2
Chen Y, He Z, Yang H et al (2013) Clinical and radiological results of total disc replacement in the cervical spine with preoperative reducible kyphosis. Int Orthop 37:463–468. https://doi.org/10.1007/s00264-012-1754-8
Zhu Y, Tian Z, Zhu B et al (2016) Bryan cervical disc arthroplasty versus anterior cervical discectomy and fusion for treatment of cervical disc diseases: a meta-analysis of prospective, randomized controlled trials. [miscellaneous article]. Spine 41:E733–E741. https://doi.org/10.1097/BRS.0000000000001367
Zheng B, Hao D, Guo H, He B (2017) ACDF vs TDR for patients with cervical spondylosis – an 8 year follow up study. BMC Surg 17:113. https://doi.org/10.1186/s12893-017-0316-9
Lei T, Liu Y, Wang H et al (2016) Clinical and radiological analysis of Bryan cervical disc arthroplasty: eight-year follow-up results compared with anterior cervical discectomy and fusion. Int Orthop 40:1197–1203. https://doi.org/10.1007/s00264-015-3098-7
Zou S, Gao J, Xu B et al (2017) Anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for two contiguous levels cervical disc degenerative disease: a meta-analysis of randomized controlled trials. Eur Spine J 26:985–997. https://doi.org/10.1007/s00586-016-4655-5
Hilibrand AS, Carlson GD, Palumbo MA et al (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528
Lee JC, Lee S-H, Peters C, Riew KD (2015) Adjacent segment pathology requiring reoperation after anterior cervical arthrodesis: the influence of smoking, sex, and number of operated levels. Spine 40:E571–E577. https://doi.org/10.1097/BRS.0000000000000846
Zhong Z-M, Zhu S-Y, Zhuang J-S et al (2016) Reoperation after cervical disc arthroplasty versus anterior cervical discectomy and fusion: a meta-analysis. Clin Orthop 474:1307–1316. https://doi.org/10.1007/s11999-016-4707-5
Alvin MD, Abbott EE, Lubelski D et al (2014) Cervical arthroplasty: a critical review of the literature. Spine J 14:2231–2245. https://doi.org/10.1016/j.spinee.2014.03.047
Sundseth J, Fredriksli OA, Kolstad F et al (2017) The Norwegian cervical arthroplasty trial (NORCAT): 2-year clinical outcome after single-level cervical arthroplasty versus fusion—a prospective, single-blinded, randomized, controlled multicenter study. Eur Spine J 26:1225–1235. https://doi.org/10.1007/s00586-016-4922-5
Yi S, Shin DA, Kim KN et al (2013) The predisposing factors for the heterotopic ossification after cervical artificial disc replacement. Spine J 13:1048–1054. https://doi.org/10.1016/j.spinee.2013.02.036
Guérin P, Obeid I, Bourghli A et al (2012) Heterotopic ossification after cervical disc replacement: clinical significance and radiographic analysis. A prospective study. Acta Orthop Belg 78:80–86
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Mazas, S., Benzakour, A., Castelain, JE. et al. Cervical disc herniation: which surgery?. International Orthopaedics (SICOT) 43, 761–766 (2019). https://doi.org/10.1007/s00264-018-4221-3
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DOI: https://doi.org/10.1007/s00264-018-4221-3