Skip to main content

Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations


Anterior cervical decompression and fusion (ACDF) is the standard for cervical discectomies. With the full-endoscopic anterior cervical discectomy (FACD) a minimally invasive procedure is available. The objective of this prospective, randomised, controlled study was to compare the results of FACD with those of ACDF in mediolateral soft disc herniations. A total of 103 patients with ACDF or FACD were followed up for two years. In addition to general parameters specific measuring instruments were used. Postoperatively 85.9% of the patients no longer had arm pain, and 10.1% had occasional pain. There were no significant clinical differences between the decompression with or without fusion. The full-endoscopic technique afforded advantages in operation technique, rehabilitation and soft tissue injury. The recorded results show that FACD is a sufficient and safe alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.


La décompression cervicale antérieure avec greffe (ACDF) est un standard de la chirurgie cervicale avec discectomies. La discectomie endoscopique FACD par voie mini-invasive est également possible. L’objectif de cette étude prospective randomisée est de comparer les résultats de cette technique endoscopique mini-invasive FACD avec la technique classique ACDF. 103 patients ayant bénéficié soit d’une ACDF soit d’une FACD ont été suivis pendant une moyenne de deux ans. après l’intervention, 85,9% des patients ne présentent aucune douleur au niveau brachial et 10,1% des douleurs occasionnelles. Il n’y a pas de différence significative que l’on ait réalisé ou non une greffe. La technique par endoscopie présente des avantages pratiques notamment en ce qui concerne la rééducation et les lésions des tissus en post-opératoires. le résultat montre que la technique FACD est une technique suffisamment sûre et es-t une alternative valable à la technique conventionnelle lorsque les critères d’indication ont été respectés. Cette technique a par ailleurs les avantages de la voie mini-invasive.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. Fraser JF, Hartl R (2007) Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 6:298–303

    Article  PubMed  Google Scholar 

  2. Baba H, Furusawa N, Tanaka Y, Wada M, Imura S, Tomita K (1994) Anterior decompression and fusion for cervical myeloradiculopathy secondary to ossification of the posterior ligament. Int Orthop 18:204–209

    CAS  PubMed  Google Scholar 

  3. Chen Y, Chen D, Wang X, Lu X, Guo Y, He Z, Tian H (2008) Anterior corperectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine. Int Orthop April 12 [Epub ahead of print]

  4. Tureyen K (2003) Disc height loss after anterior cervical microdiscectomy with titanium intervertebral cage fusion. Acta Neurochir (Wien) 145:565–569

    Article  CAS  Google Scholar 

  5. Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS (2007) Anterior cervical discectomy and fusion associated complications. Spine 32:2310–2317

    Article  PubMed  Google Scholar 

  6. Naito M, Kurose S, Oyama M, Sugioka Y (1993) Anterior cervical fusion with the Caspar instrumentation system. Int Orthop 17:73–76

    Article  CAS  PubMed  Google Scholar 

  7. Suk KS, Kim KT, Lee SH, Park SW (2006) Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop 30:290–294

    Article  PubMed  Google Scholar 

  8. Maiman DJ, Kumaresan S, Yoganadan N, Pintar FA (1999) Biomechanical effect of anterior cervical spine fusion on adjacent segments. Biomed Mater Eng 9:27–38

    CAS  PubMed  Google Scholar 

  9. Savolainen S, Rinne J, Hernesniemi J (1998) A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery 43:51–55

    Article  CAS  PubMed  Google Scholar 

  10. Hauerberg J, Kosteljanetz M, Boege-Rasmussen T, Dons K, Gideon P, Springborg JB, Wagner A (2008) Anterior cervical discectomy with or without fusion with ray titanium cage: a prospective randomized clinical study. Spine 33:458–464

    Article  PubMed  Google Scholar 

  11. Oktenoglu T, Cosar M, Ozer AF, Iplikcioglu C, Sasani M, Canbulat N, Bavbek C, Saioglu C (2007) Anterior cervical microdiscectomy with or without fusion. J Spinal Disord Tech 20:361–368

    Article  PubMed  Google Scholar 

  12. Saringer WF, Reddy B, Nobauer-Huhmann I, Regatschnig R, Reddy M, Tschabitscher M, Knosp E (2003) Endoscopic anterior cervical foraminotomy for unilateral radiculopathy: anatomical morphometric analysis and preliminary clinical experience. J Neurosurg 98:171–180

    PubMed  Google Scholar 

  13. Choi G, Lee SH, Bhanot A, Chae YS, Jung B, Lee S (2007) Modified transcorporeal anterior cervical microforaminotomy for cervical radiculopathy: a technical note and early results. Eur Spine J 16:1387–1393

    Article  PubMed  Google Scholar 

  14. Ahn Y, Lee SH, Chung SE, Park HS, Shin SW (2005) Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation. Neuroradiology 47:924–930

    Article  CAS  PubMed  Google Scholar 

  15. Roh SW, Kim DH, Cardoso AC, Fessler RG (2000) Endoscopic foraminotomy using MED system in cadaveric specimens. Spine 25:260–264

    Article  CAS  PubMed  Google Scholar 

  16. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine 33:940–948

    Article  PubMed  Google Scholar 

  17. Yang YC, Nie L, Cheng L, Hou Y (2008) Clinical and radiographic reports following cervical arthroplasty: a 24-month follow-up. Int Orthop May 22 [Epub ahead of print]

  18. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33:931–939

    Article  PubMed  Google Scholar 

  19. Ruetten S, Komp M, Merk H, Godolias G Recurrent lumbar disc herniation following conventional discectomy: A prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech (in press)

  20. Pose B, Sangha O, Peters A, Wildner M (1999) Validation of the North American Spine Society Instrument for assessment of health status in patients with chronic backache (in German). Z Orthop 137:437–441

    Article  CAS  PubMed  Google Scholar 

  21. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlmann HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528

    CAS  PubMed  Google Scholar 

  22. 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

    CAS  PubMed  Google Scholar 

  23. Abd-Alrahman N, Dokmak AS, Abou-Madawi A (1999) Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir (Wien) 141:1089–1092

    Article  CAS  Google Scholar 

  24. Peng-Fei S, Yu-Hua J (2008) Cervical disc prosthesis replacement and interbody fusion: a comparative study. Int Orthop 32:103–106

    Article  PubMed  Google Scholar 

  25. Murphy MA, Trimble MB, Piedmonte MR, Kalfas IH (1994) Changes in the cervical foraminal area after anterior discectomy with and without a graft. Neurosurgery 34:93–96

    Article  CAS  PubMed  Google Scholar 

  26. Liao JC, Niu CC, Chen WJ, Chen LH (2008) Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion. Int Orthop 32:643–648

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Sebastian Ruetten.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ruetten, S., Komp, M., Merk, H. et al. Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. International Orthopaedics (SICOT) 33, 1677 (2009).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI:


  • Disc Herniation
  • Revision Rate
  • Intervertebral Space
  • Kyphosis Angle
  • Cervical Disc Herniation