Anterior cervical discectomy without fusion: long-term results

The long-term follow-up of patients operated by one surgeon by simple anterior discectomy without fusion have been presented. The results are much better in patients with soft extruded discs than with painful discs or degenerative discs with varying degrees of radiculopathy or myelopathy. The same statement can be made for the posterior approach. The anterior approach appears to be superior for soft central extruded discs compressing the spinal cord. There appears to be a greater incidence of another disc at an adjacent level with the anterior approach than when the operation is done posteriorly. The anterior operation is an easier surgical procedure than the posterior operation in the average surgeon's hands; otherwise, it would not be as popular as it is. Interbody fusion has no long-term advantages over simple discectomy. Complications of the anterior approach, particularly with fusion, appear greater than the limited posterior approach. Rather than continue the controversy over the anterior vs. the posterior approach, it is recommended that each surgical case be evaluated to determine the preferred approach. With the passage of time, I have preferred to operate the C4, 5, and 6 ruptured discs anteriorly, as well as all central discs or hard central cervical spondylotic bars. This seems preferable to the extensive laminectomy recommended by many for spondylotic myelopathy. However, the anterior approach has been limited to two spaces rather than multiple spaces. On the rare occasions when an extensive decompression of the cervical canal is indicated, the posterior approach has been chosen. In addition, the C7 or rare T1 soft ruptured disc have been done posteriorly. When there is a doubt about the diagnosis, e.g., when a tumor is suspected or a multiple root defect associated with atypical findings on myelography, the posterior approach is preferred.