Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up

Abstract

Study design: This study retrospectively reviewed the outcomes of 126 patients treated for cervical radiculopathy with either simple anterior cervical discectomy (ACD) or anterior cervical discectomy and fusion (ACF).

Objectives: Complications, short-term, and long-term outcomes were compared to determine which was the superior procedure in the treatment of cervical radiculopathy.

Summary of background data: Both procedures were performed for identical reasons on similar patient groups in an identical manner. The ACF group had a tricortical autograft implanted after the discectomy.

Methods: Complications and short-term follow-up were determined by review of hospital and office charts and radiographs. Long-term follow-up was by phone interview.

Results: Anterior cervical discectomy had a significantly reduced mean operative time, blood loss, and hospital stay. There were 16 complications for ACF, 15 of which were graft-related and 4 complications for ACD. There was, however, no difference in mean time to return to work between the two groups. Long-term follow-up demonstrated an average low level of neck and arm pain in both groups. Continued donor site pain was not a long-term problem. Slightly more ACF than ACD patients were satisfied with the long-term results of their surgery.

Conclusions: Neither procedure is ideal for the treatment of cervical radiculopathy. Anterior cervical discectomy results in decreased hospital cost and surgical morbidity. Anterior cervical discectomy and fusion results in more rapid resolution of patient pain. The ideal procedure would appear to be ACF performed with a theoretical biomaterial that would be minimally expensive and consistently promote successful arthrodesis.