Evaluation of clinical profile, radiological and functional outcome following anterior cervical discectomy and fusion for cervical compressive myelopathy
Keywords:ACDF, Cervical discectomy, CSM, Fusion, Myelopathy, Radiology
Background: Symptomatic cervical disc prolapse is best managed with anterior cervical discectomy with or without fusion. We studied the clinical, radiological and surgical profile with postoperative outcome of the patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical compressive myelopathy at one level.
Methods: In this retrospective study, data was collected from patients who underwent ACDF for cervical compressive myelopathy in our hospital between 2016 and 2019. Clinical, radiological profile with surgical outcome were studied.
Results: A total of 283 patients were recruited. They could be followed up for a period of at least 6 months and so were recruited for the study. Out of these 283 patients (201 males; 82 females; mean age, 48.4 years, range, 22 years to 83 years), magnetic resonance imaging (MRI) cervical spine without contrast and x-ray cervical spine was available for all the patients. Nape of neck pain was the most common presenting symptom followed by tingling sensation in all four limbs and trunk. Average time taken for surgery was 2 hours 10 minutes with an average blood loss of 50 ml. Mean follow up duration was 2.7 years (range 6 months to 4 years).
Conclusions: ACDF is the treatment of choice for the patients with clinical and radiological evidence of cervical cord compression. The techniques is associated with minimal blood loss and exceptionally good surgical outcome. Following discectomy, putting an autologous graft or titanium cage improves the spine stability and maintains the cervical lordosis.
New PW, Cripps RA, Lee BB. Global maps of non-traumatic spinal cord injury epidemiology: towards a living data repository. Spinal Cord. 2014;52(2):97-109.
Klineberg E. Cervical spondylotic myelopathy: a review of the evidence. Orthoped Clin. 2010;41(2):193-202.
Brain R. Cervical spondylosis. Ann Intern Med. 1954;41(3):439-46.
Doppman JL. The mechanism of ischemia in anteroposterior compression of the spinal cord. Investig Radiol. 1975;10(6):543-51.
Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40(3):607-24.
Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15(6):602-17.
Nurjck S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972;95(1):87-100.
Tetreault L, Goldstein CL, Arnold P, Harrop J, Hilibrand A, Nouri A, Fehlings MG. Degenerative cervical myelopathy: a spectrum of related disorders affecting the aging spine. Neurosurg. 2015;77(1):51-67.
Veeravagu A, Cole T, Jiang B, Ratliff JK. Revision rates and complication incidence in single-and multilevel anterior cervical discectomy and fusion procedures: an administrative database study. Spine J. 2014;14(7):1125-31.
Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine. 2009;34(26):2886-92.
Hacker RJ. Threaded cages for degenerative cervical disease. Clin Orthopaed Rel Res. 2002;394:39-46.
Oliver JD, Goncalves S, Kerezoudis P, Alvi MA, Freedman BA, Nassr A, et al. Comparison of outcomes for anterior cervical discectomy and fusion with and without anterior plate fixation. Spine. 2018;43(7):413-22.
Bourgonjon B, Duerinck J, Moens M, D’Haens J. Comparison of the effect of anterior and posterior neurosurgical treatment for cervical spondylotic myelopathy: a clinical outcome. Acta Neurologica Belgica. 2019;119(4):585-93.
Bertalanffy H, Eggert HR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Actaneurochirurgica. 1989;99(1-2):41-50.
Fielding JW. Complications of anterior cervical disk removal and fusion. Clin Orthopaed Rel Res. 1992;284:10-3.
Flynn TB. Neurologic complications of anterior cervical interbody fusion. Spine. 1982;7(6):536-9.
Taylor BA, Vaccaro AR, Albert TJ. Complications of anterior and posterior surgical approaches in the treatment of cervical degenerative disc disease. In: Seminars in spine surgery. Vol. 11(4). WB Saunders Company; 1999: 337-346.
Jung A, Schramm J, Lehnerdt K, Herberhold C. Recurrent laryngeal nerve palsy during anterior cervical spine surgery: a prospective study. J Neurosurg Spine. 2005;2(2):123-7.
Morpeth JF, Williams MF. Vocal fold paralysis after anterior cervical diskectomy and fusion. Laryngoscope. 2000;110(1):43-6.
Karim A, Knapp J, Nanda A. Internal jugular venous thrombosis as a complication after an elective anterior cervical discectomy: case report. Neurosurg. 2006;59(3):705.
Kraus DR, Stauffer ES. Spinal cord injury as a complication of elective anterior cervical fusion. Clinical Orthopaed Rel Res. 1975;112:130-41.
Burke JP, Gerszten PC, Welch WC. Iatrogenic vertebral artery injury during anterior cervical spine surgery. Spine J. 2005;5(5):508-14.
Fountas KN, Kapsalaki EZ, Machinis T, Robinson JS. Extrusion of a screw into the gastrointestinal tract after anterior cervical spine plating. Clin Spine Surg. 2006;19(3):199-203.
Robinson RA, Walker AE, Ferlic DC, Wiecking DK. The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg. 1962;44(8):1569-87.
Joaquim AF, Murar J, Savage JW, Patel AA. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. Spine J. 2014;14(9):2246-60.
Chen CC, Huang YC, Lee ST, Chen JF, Wu CT, Tu PH. Long-term result of vocal cord paralysis after anterior cervical disectomy. Eur Spine J. 2014;23(3):622-6.