Anterior discectomy could still be an alternative to corpectomy in highly migrated cervical disc herniation

Abstract

ACDF is feasible for patients with HMCD except for cases of epidural disc prolapse adhesion or huge disc prolapse which migrates over the axial length of the vertebral body. Clinical symptoms can be significantly improved with few serious complications in those patients including ones underwent alternative ACCF due to a failed ACDF.

The Significance of Lumbar Probing Combined with Continuous Irrigation and Undercutting Posterior Vertebral Body for Highly Upward Migrated Disc Herniation in ACDF: Case Reports and technical notes

“…That might be also used to verify enough decompression. We documented that favorable outcomes without these problems, and Wang et al [3] supported these lumbar probing techniques with successful results of removing highly up migrated cervical disc herniation.…”

“…However, if there is significant up migration of the disc, use of the anterior discectomy approach may be limited due to hidden discs being located behind the vertebral bodies. Most authors advocate treatment with corpectomy instead of anterior discectomy for up migrated cervical disc to the upper level, which allows for the hidden fragments to be fully exposed and clearly removed [3].…”

“…For elderly patients and those with comorbidities, ACCF is associated with a higher rate of complications, thus more extensive perioperative evaluation and planning are necessary [8]. Due to the drawbacks of ACCF, ACDF can be considered for mild to moderate migrated disc herniation [3].…”

“…The use of corpectomy rather than discec-tomy for up migrated cervical disc herniation to the upper level was advocated [1,2]. However, compared to anterior cervical corpectomy and fusion (ACCF), anterior cervical discectomy and fusion (ACDF) may lessen the scarification of normal disc level and cervical motion, as well as the rate of adjacent segment disease (ASD) [3]. Therefore, if ACDF is feasible and successful in up migrated cervical disc herniation to the upper level, ACDF will be more beneficial to the patients compared with ACCF.…”

Surgical tactics of two-segmental cervical degenerative diseases: risk factors retrospective assessment and preoperative planning

“…Contradictory outcomes of two-level ACDF and one-level ACCF are indicated in the specialized literature. According to some data: (I) one-level ACCF is associated with the best clinical results and the frequency of fusion rate compared with two-level ACDF ( 10 ); (II) one-level ACCF and two-level ACDF have similar long-term clinical and radiological results ( 11 , 12 ); (III) one-level ACCF is associated with greater blood loss, injury risk of the dura mater and vertebral artery, high frequency of developing pseudoarthrosis compared with two-level ACDF ( 13 , 14 ). In the described clinical series, an autograph was used for corpectomy as well as a mesh implant with anterior cervical plate fixation.…”