Anterior cervical discectomy with and without interbody bone graft

Abstract

Fifty-one patients with symptomatic cervical disc disease refractory to conservative management were allocated at random to one of two treatment groups. The standard anterior approach devised by Cloward was used for 25 patients, and radical discectomy and foraminotomy for the other 26. All patients were followed for 6 months or longer with interview, physical examination, and radiographic evaluation. There was no difference in the success rate between the two groups. The large majority (92%) of patients in both groups were pleased with results of their operation. Because of technical factors related to operative exposure of the spinal canal and nerve roots, we prefer the Cloward procedure for patients symptomatic from advanced spondylosis and reserve discectomy without bone graft insertion for those with minimal spondylosis or soft disc herniations.

A systematic literature review to identify the best method for a single level anterior cervical interbody fusion

“…For completeness, these five studies have been included in Table 3, which gives an overview of the checklist score for each criterion on the checklist for the eight RCTs, but they were not analysed further. The remaining three studies were of sufficient methodological quality to be included in the review [20,32,35]. Table 4 gives an overview of the outcome measurements used in the three selected studies.…”

“…Martins [20] compared discectomy alone to the Cloward fusion procedure using an iliac crest graft. Outcome measurements were based on radiographs and a four-point scale to measure clinical outcome that summarised the findings from an interview and physical examination.…”

“…Some studies did not give clear inclusion and exclusion criteria [20,23,39], some studies included trauma in the study population [30], the duration of the complaints varied [8], and multi-level fusions were frequently included [8,20,23,30,35]. This raises the question whether the same base population was being treated.…”

“…This was probably the consequence of the fibrous cementbone interface that forms after implantation, and the fact that bone cannot invade the allograft. From the study by Martins [20] we cannot conclude that there is a difference between discectomy alone and addition of an autograft in a Cloward procedure. From the study by Savolainen et al [32], it seems that additional plating does not improve outcome.…”

First experiences with a distractible titanium implant in ventral cervical disc surgery: report on 30 consecutive cases

“…However, there is no real consensus on the useif at all [2,7,11 ] -of autologous [6,7,9,11,12], heterologous [16,17] or alloplastic materials [3,5,10,13,14] for the disc space graft for ventral fusion, the goal of which is either solid ossification or at least osseous fit. There is no doubt that autogenous iliac bone graft, with all the well-known disadvantages, is preferred.…”