Cervical discectomy. A prospective analysis of three operative techniques

Cervical disc herniation causing neurological compromise is a common affliction. Sophisticated surgical treatments have been developed throughout the twentieth century and are largely successful. Although each procedure has its supporters, it is still unclear if one surgical technique is superior.

A prospective trial was designed to evaluate the efficacy of three surgical procedures for the treatment of cervical radiculopathy caused by a unilateral acute herniated cervical disc. Patients were randomized to posterior cervical foraminotomy (FOR), and anterior cervical discectomy with (ACDF), and without (ACD) fusion. Perioperative data, office follow-up and long-term follow-up were used to compare the procedures.

All of the procedures yielded excellent relief of symptoms and signs postoperatively and during follow-up. Operative time and hospital stay were slightly shorter for ACD compared with ACDF and FOR. Reoperations occurred in all groups but there was a trend for higher recurrence at the same level with FOR and recurrence at other levels with ACDF.

All three of the procedures were successful for treatment of cervical radiculopathy caused by a herniated cervical disc. Although the numbers in this study were small, none of the procedures could be considered superior to the others. This study suggests that the selection of surgical procedure may reasonably be based on the preference of the surgeon and tailored to the individual patient.