Summary
One hundred-ninety-six patients with spinal cord or nerve root compression were operated on by anterior microsurgical discectomy without graft between 1978 and 1987. The patients presented either with spinal cord compression (33%) or radicular symptoms with a duration of 12 days to more than then years (66%). Investigations to confirm these clinical syndromes employed myelography, CT or MRI. Two-hundred-eighty-eight levels were explored; 124 one level, 54 two level, 17 three level and 2 four level operations were done. The follow-up (mean 6.7 years) showed 66% of the patients with excellent or good results after two years. The low risks of anterior discectomy were further diminished with skilful microsurgical technique without intercorporeal fusion.
A comparison of our results at follow-up with published series, in which the anterior approach was used but with intervertebral autologous bone graft after disc removal, shows no significant differences. We therefore recommend the anterior microsurgical discectomy without fusion as the treatment of choice.
Similar content being viewed by others
References
Al-Mefty O, Harkey LS, Middleton TH (1988) Myelopathy and cervical spondylotic lesions demonstrated by magnetic resonance imaging. J Neurosurg 68: 217–222
Benini A, Krayenbühl H, Brüderl R (1982) Anterior cervical discectomy without fusion. Microsurgical technique. Acta Neurochir (Wien) 61: 105–110
Bertalanffy H, Eggert HR (1988) Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases. Acta Neurochir (Wien) 90: 127–135
Cloward RB (1958) The anterior approach for removal of ruptured cervical discs. J Neurosurg 15: 602–617
Cuatico W (1981) Anterior cervical discectomy without interbody fusion. An analysis of 81 cases. Acta Neurochir (Wien) 57: 269–274
Dereymaeker A, Mulier J (1958) La fusion vertébrale par voie ventrale dans la discopathie cervicale. Rev Neurol (Paris) 99: 597–616
Frykholm R (1969) Die zervikalen Bandscheibenschäden. In: Olivecrona H, Tönnis W (eds) Handbuch der Neurochirurgie, Vol. VII/1. Springer, Berlin Heidelberg New York, pp 73–163
Gregorius FK, Estrin T, Crandall PH (1976) Cervical spondylotic radiculopathy and myelopathy. A long term follow-up study. Arch Neurol 33, 618–625
Hakuba A (1976) Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs. J Neurosurg 45, 284–291
Hankinson HL, Wilson CB (1975) Use of the operating microscope in anterior cervical discectomy without fusion. J Neurosurg 43, 452–456
Herrmann HD (1986) Chirurgische Behandlung der vertebragenen Spinalnervenerkrankungen im zervikalen und lumbosakralen Bereich. In: Hopf HC, Poeck K, Schliack H (eds) Neurologie in Praxis und Klinik, Vol 3. Georg Thieme, Stuttgart, pp 257–265
Herkowitz HN (1988) A comparison of anterior cervical fusion, cervical laminectomy, and cervical laminoplasty for the surgical management of multiple level spondylotic radiculopathy. Spine 12: 774–780
Husag L, Probst C (1984) Microsurgical anterior approach to cervical discs. Review of 60 consecutive cases of discectomy without fusion. Acta Neurochir (Wien) 73: 229–242
Lanksch WR, Haberl H, Hamburger CH (1987) Zur Diagnostik und operativen Behandlung des cervikalen Bandscheibenvorfalls und der cervikalen Myelopathie. Orthopäde 16: 424–433
Lunsford LD, Bissonnette DJ, Jannetta P, Sheptak PE, Norub DS (1980) Anterior surgery for cervical disc disease. Part 1: Treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53: 1–11
Lunsford LD, Bissonnette DJ, Zorub DS (1980) Anterior surgery for cervical disc disease. Part 2: Treatment of cervical spondylotic myelopathy in 32 cases. J Neurosurg 53: 12–19
Martins AN (1976) Anterior cervical discectomy with and without interbody bone graft. J Neurosurg 44: 290–295
Murphy MG, Gado M (1972) Anterior cervical discectomy without interbody bone graft. J Neurosurg 37: 71–74
Odom GL, Finney W, Woodhall B (1958) Cervical disc lesions. JAMA 166: 23–28
O'Laoire S, Thomas DGT (1983) Spinal cord compression due to prolapse of cervical intervertebral disc (herniation of nucleus pulposus). J Neurosurg 59: 847–853
Rosenorn J, Hansen EB, Rosenorn MA (1983) Anterior cervical discectomy with and without fusion. A prospective study. J Neurosurg 59: 252–255
Scoville WB, Dohrmann GJ, Corkill G (1976) Late results of cervical disc surgery. J Neurosurg 45: 203–210
Simeone FA, Rothman RH (1975) Cervical disc disease. In: Rothman RH, Simeone FA (eds) The spine. WB Saunders, Philadelphia
Simmons EH, Bhalla SK, Butt WP (1969) Anterior cervical discectomy and fusion. A clinical and biomechanical study with eight-year follow-up. Discography: technique and interpretation of results. J Bone Joint Surg 51 B: 225–237
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 40 A: 607–624
Sunder-Plassmann M (1976) Vordere Halsbandscheiben-Operation ohne zusätzliche Verblockung. Klinische und experimentelle Untersuchungen. Fortschr Med 94: 322–326
Verbiest H (1968) A lateral approach to the cervical spine: Technique and indications. J Neurosurg 28: 191–203
Wilson DH, Campbell DD (1977) Anterior cervical discectomy without bone graft. Report of 71 cases. J Neurosurg 47: 551–555
Yaşargil MG (1969) Microsurgery applied to neurosurgery. Georg Thieme, Stuttgart, pp 177–178
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Klaiber, R.D., von Ammon, K. & Sarioglu, A.C. Anterior microsurgical approach for degenerative cervical disc disease. Acta neurochir 114, 36–42 (1992). https://doi.org/10.1007/BF01401112
Issue Date:
DOI: https://doi.org/10.1007/BF01401112