Abstract
The preferred approach for fusion of the middle cervical spine (C3–C7) and cervicothoracic junction is the anterior one.
During 1950 a novel cervical spine surgical technique emerged: in 1955 Smith G.W. and Robinson R.A. developed a surgical technique concerning anterior removal of cervical disc and replace it with a rectangular bone graft.
Afterwards, Cloward in 1958 developed a different technique which consists in milling the anterior profile between two adjacent vertebras, filling it with a bone cylindrical autograft dowel, after the disc removal (Cloward RB, J Neurosurg. 15(6):602–17, 1958).
At today, Anterior Cervical Discectomy and fusion (ACDF), as Cloward or Smith Robinson designed, is worldwidely adopted (Fig. 14.1).
Nowadays, fusion is performed with cages, stand-alone, or reinforced with plates or with a posterior instrumentation. A new type of stand-alone cage, provided with lag screws, work as a cage-plate construct with a single implantable.
We personally prefer this new cages, manufactured with a low profile and biomechanically comparable to the standard cages with a separate plate.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15(6):602–17. https://doi.org/10.3171/jns.1958.15.6.0602.
Goffin J, Geusens E, Vantomme N, Quintens E, Waerzeggers Y, Depreitere B, Van Calenbergh F, van Loon J. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech. 2004;17(2):79–85. https://doi.org/10.1097/00024720-200404000-00001.
Ebraheim NA, Lu J, Skie M, Heck BE, Yeasting RA. Vulnerability of the recurrent laryngeal nerve in the anterior approach to the lower cervical spine. Spine (Phila Pa 1976). 1997;22(22):2664–7. https://doi.org/10.1097/00007632-199711150-00015.
Kilburg C, Sullivan HG, Mathiason MA. Effect of approach side during anterior cervical discectomy and fusion on the incidence of recurrent laryngeal nerve injury. J Neurosurg Spine. 2006;4(4):273–7. https://doi.org/10.3171/spi.2006.4.4.273.
Cheung KM, Mak KC, Luk KD. Anterior approach to cervical spine. Spine (Phila Pa 1976). 2012;37(5):E297–302. https://doi.org/10.1097/BRS.0b013e318239ccd8.
Nassr A, Lee JY, Bashir RS, Rihn JA, Eck JC, Kang JD, Lim MR. Does incorrect level needle localization during anterior cervical discectomy and fusion lead to accelerated disc degeneration? Spine (Phila Pa 1976). 2009;34(2):189–92. https://doi.org/10.1097/BRS.0b013e3181913872.
Watters WC 3rd, Levinthal R. Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up. Spine (Phila Pa 1976). 1994;19(20):2343–7. https://doi.org/10.1097/00007632-199410150-00016.
Epstein JA, Carras R, Lavine LS, Epstein BS. The importance of removing osteophytes as part of the surgical treatment of myeloradiculopathy in cervical spondylosis. J Neurosurg. 1969;30(3):219–26. https://doi.org/10.3171/jns.1969.30.3part1.0219.
Song KJ, Lee KB. A preliminary study of the use of cage and plating for single-segment fusion in degenerative cervical spine disease. J Clin Neurosci. 2006;13(2):181–7. https://doi.org/10.1016/j.jocn.2005.02.018.
Chen Y, Chen H, Wu X, Wang X, Lin W, Yuan W. Comparative analysis of clinical outcomes between zero-profile implant and cages with plate fixation in treating multilevel cervical spondilotic myelopathy: a three-year follow-up. Clin Neurol Neurosurg. 2016;144:72–6. https://doi.org/10.1016/j.clineuro.2016.03.010.
Cheung ZB, Gidumal S, White S, Shin J, Phan K, Osman N, Bronheim R, Vargas L, Kim JS, Cho SK. Comparison of anterior cervical discectomy and fusion with a stand-alone interbody cage versus a conventional cage-plate technique: a systematic review and meta-analysis. Global Spine J. 2019;9(4):446–55. https://doi.org/10.1177/2192568218774576.
Scholz M, Reyes PM, Schleicher P, Sawa AG, Baek S, Kandziora F, Marciano FF, Crawford NR. A new stand-alone cervical anterior interbody fusion device: biomechanical comparison with established anterior cervical fixation devices. Spine (Phila Pa 1976). 2009;34(2):156–60. https://doi.org/10.1097/BRS.0b013e31818ff9c4.
Lu VM, Mobbs RJ, Fang B, Phan K. Clinical outcomes of locking stand-alone cage versus anterior plate construct in two-level anterior cervical discectomy and fusion: a systematic review and meta-analysis. Eur Spine J. 2019;28(1):199–208. https://doi.org/10.1007/s00586-018-5811-x.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Balsano, M., Vacchiano, A., Spina, M., Ulgelmo, M., Calzi, D. (2022). Anterior Cervical Approaches: Decompression and Fusion with Cages. In: Menchetti, P.P.M. (eds) Cervical Spine. Springer, Cham. https://doi.org/10.1007/978-3-030-94829-0_14
Download citation
DOI: https://doi.org/10.1007/978-3-030-94829-0_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-94828-3
Online ISBN: 978-3-030-94829-0
eBook Packages: MedicineMedicine (R0)