Anterior cervical microdiscectomy with or without fusion

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Anterior cervical microdiscectomy (ACD) is a common surgical treatment for cervical disc herniation.
• The necessity of performing fusion after discectomy remains a subject of debate.
• A multicentric, prospective, randomized study was conducted to address this controversy.

Purpose of the Study:

• To compare the outcomes of simple ACD versus ACD with semirigid plate fusion.
• To evaluate the impact of fusion on pain, disc height, and neural foramen dimensions.
• To assess the long-term efficacy and potential complications of each surgical technique.

Main Methods:

• Twenty patients with cervical disc herniation were enrolled and randomized into two groups.
• Group 1: Eleven patients underwent simple ACD.
• Group 2: Nine patients underwent ACD with semirigid plate fusion.
• Preoperative and postoperative (immediate, 1-day, 1-year) CT scans and X-rays were analyzed.
• Measurements included cervical disc height, neural foramen height, and visual analog pain scale (VAPS).
• Statistical analysis was performed using the Mann-Whitney test.

Main Results:

• Both surgical techniques yielded satisfactory outcomes and significantly reduced arm pain.
• Neck pain improvement was significant only in the fusion group.
• No significant changes in disc or neural foramen height were observed at adjacent levels.
• Simple ACD led to significant disc height and neural foramen narrowing at 1-year follow-up.
• ACD with fusion showed immediate disc height increase but significant narrowing by 1-year follow-up.
• Fusion with semirigid plates resulted in less disc height narrowing compared to simple ACD at 1 year.

Conclusions:

• ACD is effective for cervical disc herniation, with or without fusion.
• Semirigid plate fusion offers temporary advantages in disc height and neural foramen dimensions.
• The benefits of semirigid plates are limited due to potential subsidence.
• Fusion with semirigid plates provides a significant advantage in preventing disc height narrowing compared to simple ACD over the long term.