Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease.

There were 55 patients (soft disc, 21 and spondylosis, 34) who underwent anterior cervical discectomy without fusion (ACD) using an operating microscope. Discectomy of a single level was performed on 48 cases and two levels on 7. There were 37 patients with radiculopathy, and 18 patients with myelopathy or myeloradiculopathy who were followed clinically for 2-13 years postoperatively. Overall 81% of patients were improved in soft disc herniation, and no significant differences were noted between the group of radiculopathy and myelopathy. In spondylosis all but one patient reported initial relief of their preoperative symptoms; however, overall improvement was noted in only 16 patients (47%). The causes of symptomatic deterioration after ACD for spondylosis were later symptomatic recurrence in 5 patients, severe neck pain in 4, and development of new symptoms due to adjacent spur formation in 2. The authors eventually added interbody fusion in 4 cases. Cervical spine roentgenograms almost always showed a loss of height of the interspace and an anterior angulation immediately after ACD, but the alignment of the spine tended to improve with time, so that, at last follow-up, 82% had a good alignment. A spontaneous osseous fusion occurred in 74% of cases. An adjacent spur formation was observed in 3 patients with spondylosis. The most troublesome complication was neck and/or scapular pain. This pain usually subsided spontaneously, but this continued for more than 4 years postoperatively in 4 patients with spondylosis. Using an operating microscope ACD is a safe and effective procedure for patients with soft disc herniation, but the authors still prefer anterior cervical discectomy with interbody fusion for the patients with advanced spondylosis.