Anterior cervical discectomy and fusion in the era of motion preserving surgery

Abstract

Background. Anterior cervical discectomy and fusion is accepted as the standard surgical treatment of cervical spondylotic myelopathy. Cervical disc arthroplasty has gained widespread acceptance as an alternate choice for ACDF. We intend to present the clinical and radiologic outcomes of patients who underwent ACDF in our department. Methods. Designed as a retrospective study, the primary objective was to assess the nonunion in patients undergoing ACDF and Anterior cervical Corpectomy and fusion. The article discusses the outcome for the discectomy group. All patients who underwent ACDF for CSM from January 2014 to December 2018 were included. Patients who underwent posterior fusion in addition to anterior approach, revision surgery and congenital anomalies of the spine were excluded. Of the 230 eligible patients,46 subjects were part of the study. They underwent neurologic and radiographic examination and their past records were examined. Neurologic outcome was assessed using Nurick grade and mJOA score. Dysphagia was assessed using the Bazaz score. Neck radiographs were analysed for fusion, Adjacent segment Disease, subsidence, cervical and segmental lordosis. Results. The overall response rate was 25.65%. The mean follows up duration was 4 years. The mean age of the population was 47.1 years. The most common operating level was C5/6. The neurologic status of patients improved from the baseline. There was mild transient dysphagia in 5(10.9%) patients. The overall rate of fusion was 91.3%. Subsidence was seen in 10.9%. Degenerative changes were noted in postop x rays of 67.4% of patients. There was no mortality. Conclusion. ACDF achieves thorough decompression thereby resulting in neurologic improvement. It produces effective and sustained neurologic improvement. Preoperative adjacent segment degenerative changes were significantly associated with the development of ASD during follow up. This is can due to the progression of the disease. Though the procedure improves the lordosis, it tends to decrease with follow up.