Skip to main content
SpringerLink
Log in

Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy

A follow-up of 164 cases

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Between 1976 and 1983, 251 patients underwent surgery for the treatment of cervical degenerative disc disease. Anterior microsurgical discectomy at one or more cervical segments without interbody fusion was performed in each case. 109 patients with radiculopathy and 55 patients with myelopathy were followed up clinically 1 to 8 years postoperatively. A soft disc lesion was found in 72, a hard disc lesion in 92 patients. Of all radicular symptoms and signs, brachialgia and motor deficits of the upper extremities showed the highest improvement rates. The medullary complaints were improved in 80%, the progression of the disease was arrested in 93% of myelopathic cases.

An excellent or good long-term result was achieved in 82% of patients with radiculopathy and 55% of those with myelopathy. The outcome was best in cases with soft disc lesions, with monosegmental disease, in individuals under 50 years of age, and in patients with a sudden onset and a short duration of symptoms. These results are comparable with those obtained by other surgical methods.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arnasson O, Carlsson CA, Pellettieri L (1987) Surgical and conservative treatment of cervical spondylotic radiculopathy and myelopathy. Acta Neurochir (Wien) 84: 48–53

    Google Scholar 

  2. Aronson N, Bagan M, Filtzer DL (1970) Results of using the Smith-Robinson approach for herniated and extruded cervical discs. Technical note. J Neurosurg 32: 721–722

    PubMed  Google Scholar 

  3. Bailey RW, Badgley CE (1960) Stabilization of the cervical spine by anterior fusion. J Bone Joint Surg 42-A: 565–594

    Google Scholar 

  4. Benini A, Krayenbühl H, Brüderl R (1982) Anterior cervical discectomy without fusion. Microsurgical technique. Acta Neurochir (Wien) 61: 105–110

    Google Scholar 

  5. Bertalanffy H, Eggert H-R, Complications of anterior cervical discectomy without fusion in 450 consecutive patients (in preparation)

  6. Bertalanffy H, Eggert H-R, Gilsbach J (1988) Langzeitergebnisse nach fusionsloser zervikaler Bandscheibenoperation (Diskektomie) unter besonderer Berücksichtigung einiger arbeitsmedizinischer Aspekte. In: Hohmann D, Kügelgen B, Liebig K, Schirmer M (eds) Neuroorthopädie 4. Springer, Berlin Heidelberg New York Tokyo (in press)

    Google Scholar 

  7. Boldrey EB (1964) Anterior cervical decompression (without fusion). Presented at the American Academy of Neurological Surgery, Key Biscayne, Florida

    Google Scholar 

  8. Bollati A, Galli G, Gandolfini M, Marini G, Gatta G (1983) Microsurgical anterior cervical disk removal without interbody fusion. Surg Neurol 19: 329–333

    PubMed  Google Scholar 

  9. Busch G, Schürmann K, Samii M (1975) First experiences with the anterior discectomy without fusion of the cervical spine in cases of acute disc rupture. In: Penzholz H, Brock M, Hamer J, Klinger M, Spoerri O (eds), Advances in neurosurgery, Vol 3. Springer, Berlin Heidelberg New York, pp 357–363

    Google Scholar 

  10. Cloward RB (1962) New method of diagnosis and treatment of cervical disc disease. Clin Neurosurg 8: 93–132

    PubMed  Google Scholar 

  11. Cloward RB (1958) The anterior approach for removal of ruptured cervical discs. J Neurosurg 15: 602–617

    PubMed  Google Scholar 

  12. Conolly ES, Seymour RJ, Adams JE (1965) Clinical evaluation of anterior cervical fusion for degenerative cervical disc disease. J Neurosurg 23: 431–437

    PubMed  Google Scholar 

  13. Coppola AR (1978) Anterior cervical dicectomy (Letter). J Neurosurg 49: 781

    PubMed  Google Scholar 

  14. Crandall PH, Batzdorf U (1966) Cervical spondylotic myelopathy. J Neurosurg 25: 57–66

    PubMed  Google Scholar 

  15. Crandall PH, Gregorius FK (1977) Long-term follow-up of surgical treatment of cervical spondylotic myelopathy. Spine 2: 139–146

    Google Scholar 

  16. Cuatico W (1981) Anterior cervical discectomy without interbody fusion. An analysis of 81 cases. Acta Neurochir (Wien) 57: 269–274

    Google Scholar 

  17. Dereymaeker A, Ghosez J-P, Henkes R (1963) Le traitement chirurgical de la discopathie cervicale. Résultats comparés de l'abord postérieur (laminectomie) et de l'abord ventral (fusion corporéale), dans une cinquantaine de cas personels. Neurochirurgie 9: 13–20

    PubMed  Google Scholar 

  18. Dohn DF (1966) Anterior interbody fusion for treatment of cervical-disc conditions. JAMA 197: 897–900

    PubMed  Google Scholar 

  19. Dunsker SB (1976) Anterior cervical discectomy with and without fusion. Clin Neurosurg 24: 516–521

    Google Scholar 

  20. Epstein JA, Carras R, Lavine LS, Epstein BS (1969) The importance of removing osteophytes as part of the surgical treatment of myeloradiculopathy in cervical spondylosis. J Neurosurg 30: 219–226

    PubMed  Google Scholar 

  21. Eriksen EF, Buhl M, Fode K, Klaerke A, Kroyer L, Lindeberg H, Madsen CB, Strange P, Wohlert L, Espersen JO (1984) Treatment of cervical disc disease using Cloward's technique. The prognostic value of clinical preoperative data in 1,106 patients. Acta Neurochir (Wien) 70: 181–197

    Google Scholar 

  22. Fager CA (1973) Results of adequate posterior decompression in the relief of spondylotic cervical myelopathy. J Neurosurg 38: 684–692

    PubMed  Google Scholar 

  23. Gilsbach J, Bertalanffy H, Spöhr G, Radiological long-term findings after discectomy without fusion (in preparation)

  24. Gilsbach J, Eggert H-R, Best S (1981) Vor- und Nachteile der vorderen zervikalen Bandscheibenoperation ohne Verblockung. Z Orthop 119: 600–601

    Google Scholar 

  25. Giombini S, Solero CL (1980) Considerations on 100 anterior cervical discectomies without fusion. In: Grote W, Brock M, Clar HE, Klinger M, Nau HE (eds) Advances in neurosurgery, vol 8. Springer, Berlin Heidelberg New York, pp 302–307

    Google Scholar 

  26. Granata F, Taglialatela G, Graziussi G, Avella F, Terracciano AM (1981) Management of cervical disk protrusions by anterior discectomy without fusion. J Neurosurg Sci 25: 231–234

    PubMed  Google Scholar 

  27. Gregorius FK, Estrin T, Crandall PH (1976) Cervical spondylotic radiculopathy and myelopathy. A long-term follow-up study. Arch Neurol 33: 618–625

    PubMed  Google Scholar 

  28. Gros C, Privat JM, Safdari H (1984) Exérèse discale sans greffe dans le traitement des cervico-brachialgies. Acta Orthop Belg 50 (1): 33–38

    PubMed  Google Scholar 

  29. Guarnaschelli JJ, Dzenitis AJ (1982) Anterior cervical discectomy without fusion: comparison study and follow-up. In: Brock M (ed) Modern neurosurgery 1, Springer, Berlin Heidelberg New York, pp 284–291

    Google Scholar 

  30. Guidetti B, Fortuna A (1969) Long-term results of surgical treatment of myelopathy due to cervical spondylosis. J Neurosurg 30: 714–721

    PubMed  Google Scholar 

  31. Hakuba A (1976) Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs. J Neurosurg 45: 284–291

    PubMed  Google Scholar 

  32. Hankinson HL, Wilson CB (1975) Use of the operating microscope in anterior cervical discectomy without fusion. J Neurosurg 43: 452–456

    PubMed  Google Scholar 

  33. Henderson CM, Hennessy RG, Shuey HM, Shackelford EG (1983) Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: A review of 846 consecutively operated cases. Neurosurg 13: 504–512

    Google Scholar 

  34. Hirsch C (1960) Cervical disc rupture. Diagnosis and therapy. Acta Orthop Scand 30: 172–186

    Google Scholar 

  35. Hirsch C, Wickbom I, Lidström A, Rosengren K (1964) Cervical disc resection. A follow-up of myelographic and surgical procedure. J Bone Joint Surg 46-A: 1811–1821

    Google Scholar 

  36. Hoff JT, Wilson CB (1978) Microsurgical approach to the anterior cervical spine and spinal cord. Clin Neurosurg 26: 513–528

    Google Scholar 

  37. Husag L, Probst Ch (1981) Antero-laterale, zervikale mikrochirurgische Discektomie. Schweiz Arch Neurol Neurochir Psychiatr 129: 47–59

    PubMed  Google Scholar 

  38. Husag L, Probst Ch (1984) Microsurgical anterior approach to cervical discs. Review of 60 consecutive cases of discectomy without fusion. Acta Neurochir (Wien) 73: 229–242

    Google Scholar 

  39. Jacobs B, Krueger EG, Leivy DM (1970) Cervical spondylosis with radiculopathy. Results of anterior discectomy and interbody fusion. JAMA 211: 2135–2140

    PubMed  Google Scholar 

  40. Jeffreys RV (1979) The surgical treatment of cervical spondylotic myelopathy. Acta Neurochir (Wien) 47: 293–305

    Google Scholar 

  41. Jomin M, Lesoin F, Lozes G, Thomas III CE, Rousseaux M, Clarisse J (1986) Herniated cervical discs. Analysis of a series of 230 cases. Acta Neurochir (Wien) 79: 107–113

    Google Scholar 

  42. Kadoya S, Nakamura T, Kwak R, Hirose G (1985) Anterior osteophytectomy for cervical spondylotic myelopathy in developmentally narrow canal. J Neurosurg 63: 845–850

    PubMed  Google Scholar 

  43. Kadoya S, Kwak R, Hirose G, Yamamoto T (1982) Cervical spondylotic myelopathy treated by a microsurgical anterior approach with or without interbody fusion. In: Brock M (ed) Modern neurosurgery 1. Springer, Berlin Heidelberg New York, pp 292–298

    Google Scholar 

  44. Kosary IZ, Braham J, Shacked I, Shacked R (1976) Microsurgery in anterior approach to cervical discs. Surg Neurol 6: 275–277

    PubMed  Google Scholar 

  45. Landmann JA, Hoffmann Jr. JC, Braun IF, Barrow DL (1984) Value of computed tomographic myelography in the recognition of cervical herniated disc. AJNR 5: 391–394

    PubMed  Google Scholar 

  46. Lesoin F, Bouasakao N, Clarisse J, Rousseaux M, Jomin M (1985) Results of surgical treatment of radiculomyelopathy caused by cervical arthrosis based on 1,000 operations. Surg Neurol 23: 350–355

    PubMed  Google Scholar 

  47. Lunsford LD, Bissonette DJ, Jannetta PJ, Sheptak PE, Zorub DS (1980) Anterior surgery for cervical disc disease. Part 1: Treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53: 1–11

    PubMed  Google Scholar 

  48. Lunsford LD, Bissonette 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

    PubMed  Google Scholar 

  49. Mann KS, Khosla VK, Gulati DR (1984) Cervical spondylotic myelopathy treated by a single-stage multilevel anterior decompression. J Neurosurg 60: 81–87

    PubMed  Google Scholar 

  50. Mayfield FH (1966) Cervical spondylosis: a comparison of the anterior and posterior approaches. Clin Neurosurg 13: 181–188

    Google Scholar 

  51. Martins AN (1976) Anterior cervical discectomy with and without interbody bone graft. J Neurosurg 44: 290–295

    PubMed  Google Scholar 

  52. McPherson WF (1977) Advantage of anterior cervical discectomy. J Tenn Med Assoc 70: 879–880

    PubMed  Google Scholar 

  53. Miyasaka K, Isu T, Iwasaki Y, Abe S, Takei H, Tsuru M (1983) High resolution computed tomography in the diagnosis of cervical disc disease. Neuroradiology 24: 253–257

    PubMed  Google Scholar 

  54. Modic MT, Weinstein MA, Pavlicek W, Boumphrey F, Starnes D, Duchesneau PM (1983) Magnetic resonance imaging of the cervical spine: technical and clinical observations. AJR 141: 1129–1136

    PubMed  Google Scholar 

  55. Mosdal C (1984) Cervical osteochondrosis and disc herniation. Eighteen years' use of interbody fusion by Cloward's technique in 755 cases. Acta Neurochir (Wien) 70: 207–225

    Google Scholar 

  56. Mosdal C, Overgaard J (1984) Lateral cervical fecetectomy. The surgical pathology of radicular brachialgia. Acta Neurochir (Wien) 70: 199–205

    Google Scholar 

  57. Murphy MG, Gado M (1972) Anterior cervical discectomy without interbody bone graft. J Neurosurg 37: 71–74

    PubMed  Google Scholar 

  58. Nurick S (1972) The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain 95: 101–108

    PubMed  Google Scholar 

  59. Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95: 87–100

    PubMed  Google Scholar 

  60. Odom GL, Finney W, Woodhall B, Durham NC (1958) Cervical disc lesions. JAMA 166: 23–28

    Google Scholar 

  61. O'Laoire SA, Thomas DGT (1983) Spinal cord compression due to prolapse of cervical intervertebral disc (herniation of nucleus pulposus). J Neurosurg 59: 847–853

    PubMed  Google Scholar 

  62. Phillips DG (1973) Surgical treatment of myelopathy with cervical spondylosis. J Neurol Neurosurg Psychiatry 36: 879–884

    PubMed  Google Scholar 

  63. Reynolds AF (1979) Epidural bleeding in anterior discectomy (Letter). J Neurosurg 50: 126

    PubMed  Google Scholar 

  64. Robertson JT, Johnson SD (1980) Anterior cervical discectomy without fusion: long-term results. Clin Neurosurg 27: 440–449

    PubMed  Google Scholar 

  65. Robertson JT (1978) Anterior operations for herniated cervical disc and for myelopathy. Clin Neurosurg 25: 245–250

    PubMed  Google Scholar 

  66. Robertson JT (1973) Anterior removal of cervical disc without fusion. Clin Neurosurg 20: 259–261

    PubMed  Google Scholar 

  67. Robinson RA, Smith GW (1955) Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull John Hopkins Hosp 96: 223–224

    Google Scholar 

  68. Roosen K, Grote W (1980) Late results of operative treatment of cervical myelopathy. In: Grote W, Brock M, Clar HE, Klinger M, Nau HE (eds) Advances in neurosurgery, vol 8. Springer, Berlin Heidelberg New York, pp 69–77

    Google Scholar 

  69. Rosenørn J, Hansen EB, Rosenørn M-A (1983) Anterior cervical discectomy with and without fusion. A prospective study. J Neurosurg 59: 252–255

    PubMed  Google Scholar 

  70. Russel EJ, D'Angelo CM, Zimmermann RD, Czervionke LF, Huckmann MS (1984) Cervical disc herniation: CT demonstration after contrast enhancement. Radiology 152: 703–712

    PubMed  Google Scholar 

  71. Scoville WB (1966) Types of cervical disc lesions and their surgical approaches. JAMA 196: 479–481

    PubMed  Google Scholar 

  72. Scoville WB, Dohrmann GJ, Corkill G (1976) Late results of cervical disc surgery. J Neurosurg 45: 203–210

    PubMed  Google Scholar 

  73. Seeger W (1982) Microsurgery of the spinal cord and surrounding structures. Springer, Wien New York

    Google Scholar 

  74. Simmons EH, Bhalla SK, Butt WP (1969) Anterior cervical discectomy and fusion. A clinical and biomechanical study with eight-year follow-up. J Bone Joint Surg 51B: 225–237

    Google Scholar 

  75. 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

    PubMed  Google Scholar 

  76. Sprenkel van der JWB, Mauser HW, Huynen CHJN, Kneepkens RHAM, Tulleken CAF (1986) MRI in neurosurgical diagnosis and management of craniocervical junction and cervical spine pathology. Clin Neurol Neurosurg 88: 245–251

    PubMed  Google Scholar 

  77. Susen AF (1966) Simple anterior cervical discectomy without fusion. Presented at the American Academy of Neurological Surgery, San Francisco, California

  78. Tew JM Jr., Mayfield FH (1975) Anterior cervical discectomy-a microsurgical approach (Abstract). J Neurol Neurosurg Psychiatry 38: 413

    Google Scholar 

  79. Tew JM Jr., Mayfield FH (1976) Complications of surgery of the anterior cervical spine. Clin Neurosurg 23: 424–434

    PubMed  Google Scholar 

  80. Tribolet N de, Zander E (1981) Anterior discectomy without fusion for the treatment of ruptured cervical discs. J Neurosurg Sci 25: 217–220

    PubMed  Google Scholar 

  81. U HS, Wilson CB (1978) Postoperative epidural hematoma as a complication of anterior cervical discectomy. J Neurosurg 49: 288–291

    PubMed  Google Scholar 

  82. Wiberg J (1986) Effects of surgery on cervical spondylotic myelopathy. Acta Neurochir (Wien) 81: 113–117

    Google Scholar 

  83. Wilson DH, Campbell DD (1977) Anterior cervical discectomy without bone graft. J Neurosurg 47: 551–555

    PubMed  Google Scholar 

  84. Wohlert L, Buhl M, Eriksen EF, Fode K, Klærke A, Kroyer L, Lindeberg H, Madsen CB, Strange P, Espersen JO (1984) Treatment of cervical disc disease using Cloward's technique. III. Evaluation of cervical spondylotic myelopathy in 138 cases. Acta Neurochir (Wien) 71: 121–131

    Google Scholar 

Download references

Author information

Author notes

  1. H. Bertalanffy

    Present address: Department of General Neurosurgery, University of Freiburg i. Br., Federal Republic of Germany

Authors and Affiliations

  1. Department of General Neurosurgery, University of Freiburg i. Br., Federal Republic of Germany

    H. -R. Eggert

Authors
  1. H. Bertalanffy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. -R. Eggert
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bertalanffy, H., Eggert, H.R. Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. Acta neurochir 90, 127–135 (1988). https://doi.org/10.1007/BF01560567

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01560567

Keywords

Search

Navigation