Posterior approach for soft cervical disc herniation: a neglected technique?

The ideal approach to the treatment of soft cervical disc herniation remains controversial. Recent reports emphasize several variations of anterior cervical approaches, including the introduction of instrumentation techniques. New issues have been raised and modern neurosurgeons seem to be less familiar with the posterior approach. The objective of this study was to analyze the results obtained by surgical treatment via a posterior approach of soft cervical disc herniation.

Fifty-one patients who underwent laminectomy/flavectomy and disc removal for the treatment of soft cervical disc herniation in the period of 1990 to 1999 were analyzed retrospectively. Relief of pain and motor and sensory improvement were the criteria used to measure the success of the procedure.

Most of the patients presented with acute radiculopathy. Radicular involvement was as follows: 25 cases-C7 root, 19 cases-C6 root, 4 cases-C5 root, and 3 cases-C8 root. Total relief of pain was obtained in 49 of 51 patients (96%). Motor improvement was obtained in 35 of 46 patients (76%) and sensory improvement in 22 of 35 patients (62.8%) in the short term. The mean time of hospitalization was 3 days. There was no mortality and no morbidity.

The advantage of this method, in selected cases, over the classical anterior approach, is that there is no need for grafting, thus avoiding the additional pain and possible complications at the donor and receptor sites, while obtaining similar results.