Microsurgical anterior approach to cervical discs review of 60 consecutive cases of discectomy without fusion

Abstract

During the past six years 60 patients have undergone anterior cervical microsurgical discectomy without exogenous intercorporal grafting using the operating microscope. This alternative method of treatment is a further refinement of previous techniques for the removal of cervical disc protrusions, which fulfils all the criteria of effective surgery. Discectomy provides ample exposure of the neural elements through the disc space. The visualisation of the underlying pathology is adequate through direct light and magnification of the operating microscope. A radical surgery is possible without danger of injury to the nervous structures or to the vertebral artery. The functional stability of the adjacent vertebral segment is, present immediately after discectomy. A spontaneous fusion occurs in 70% of cases in six months to one year. Risks and complications of the procedure are few. Long term results are excellent, with overall benefit from surgery in 95% of cases. Comparing the results of anterior microdiscectomy without bone grafting with those of other procedures, there are no significant differences.

Use of an empty, plasmapore-covered titanium cage for interbody fusion after anterior cervical microdiscectomy

“…10,26,36 Whether patients develop symptoms may depend on time of follow-up. 10,25 Whether this is related to the different design of the cages is unknown and needs further investigation. 3 As the range of motion varies in different types of cages, this not only has influence on the primary cervical stability but also on the subsidence.…”

“…2,6,13 Prior to the introduction of ACDF using PCTC or bone graft, ACD was routinely performed in our department. Husag et al 25 reported the results of 60 patients undergoing microsurgical ACD during a 6-year period in our institution. The authors reported an excellent overall benefit in 95% of the patients after 6 and 12 months with a lower incidence of complications compared to previous series.…”

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

“…Many surgeons do not interpose a graft into the empty intervertebral disc space [2,7,11]. In our opinion, this procedure is unsafe and not advisable because of the danger of subsequent kyphosis of the cervical spine [2,6], especially if the uncinate processes are resected for adequate nerve root decompression.…”

“…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.…”

Spontaneous Interbody Fusion After Controlled Injuries to the Spine: An Experimental Study in Rabbits

“…Many theories have been formulated since then, most of which implicate hematoma as the main cause of bone formation and subsequent fusion, as well as injuries of the soft tissues or the coexistence of a fracture. Spontaneous traumatic fusion has been associated with the type of injury (4,6,9,10,13,15), immobilization (3,8), and soft-tissue distraction (2,3). The mechanism of injury was also associated with spontaneous fusion (2).…”