Complications in Anterior Cervical Discectomy and Fusion for Cervical Degenerative Disc Disease

Abstract

Since the first publication by Robinson and Smith in 1955 using the iliac crest graft (5), the ACDF is an effective and technically well established surgical procedure for the management of symptomatic cervical degenerative disc disease (CDD). Certainly, with the course of time and the technological advances that subsequently occurred, both the devices and the surgical technique used have changed. Initially, the interbody support was always performed with autologous bone graft (tricortical iliac crest bone graft) in the early part of most of the series; later, a metal plate, secured with transcortical screws to the vertebral bodies, was added to give better support to the autograft. Later, allograft cervical spacers with demineralized bone matrix were introduced; also it has been used with polyetheretherketone cages, especially in multilevel cases or in patients with a history of smoking, osteoporosis, osteopenia, chronic steroid use, and osteomalacia, in which the bone matrix is weak (1). More recently, it has been used as a dynamic disc, introducing the concept of maintaining the biomechanics and motility of the segment treated, with different outcomes and complications that are not related to the topic to be discussed in this Perspective.