Cervical disc herniation: which surgery?
- 220 Downloads
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.
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.
Anterior cervical decompression and fusion remain the gold standard for surgical treatment of cervical disc herniation.
KeywordsCervical disc herniation Cervical disc arthroplasty Anterior cervical decompression
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 8.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 CrossRefGoogle Scholar
- 10.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 CrossRefGoogle Scholar
- 11.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 38:881–884Google Scholar
- 16.Scoville WB (1945) Recent developments in the diagnosis and treatment of cervical ruptured intervertebral discs. Proc Am Fed Clin Res 2:23Google Scholar
- 28.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 94:174–178Google Scholar
- 32.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 CrossRefGoogle Scholar
- 35.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 CrossRefGoogle Scholar
- 40.Fernström U (1966) Arthroplasty with intercorporal endoprothesis in herniated disc and in painful disc. Acta Chir Scand Suppl 357:154–159Google Scholar
- 43.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 CrossRefGoogle Scholar
- 46.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 CrossRefGoogle Scholar
- 51.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 CrossRefGoogle Scholar
- 53.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 78:80–86Google Scholar