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Current concepts of anterior cervical discectomy and fusion: a review of literature.

Song KJ, Choi BY - Asian Spine J (2014)

Bottom Line: Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported.To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established.Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Biomedical Science Institute, Chonbuk National University Medical School, Jeonju, Korea.

ABSTRACT
Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported. To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established. Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

No MeSH data available.


Related in: MedlinePlus

Autogenous bone graft techniques. (A) Smith-Robinson graft (horseshoe). (B) Cloward graft (dowel). (C) Bailey-Badgley graft (onlay strut). (D) Simmons-Bhalla graft (keystone).
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Figure 1: Autogenous bone graft techniques. (A) Smith-Robinson graft (horseshoe). (B) Cloward graft (dowel). (C) Bailey-Badgley graft (onlay strut). (D) Simmons-Bhalla graft (keystone).

Mentions: Anterior cervical approach which is familiar to the spine surgeon was initially described by Lahey and Warren [2] to expose esophageal diverticula. Smith and Robinson [3] first applied this approach to cervical spine and reported the result of anterior cervical interbody fusion by using a horseshoe-shaped graft harvested from iliac crest in 14 patients suffering from radiculopathy. At that time there was no attempt to remove the structure compressing neural structure and simply disc was removed and autologous bone graft was filled in the hollow space to conduct the fusion. They expected that the inserted graft will indirectly decompress nerve root by recovering the disc height, and it was thought that existing osteophytes would regress wtith stabilization of the involved motion segment. Consequently, 9 patients had excellent and 4 patients had good or fair results. The reason that anterior cervical fusion came to the fore, was that the effort for overcoming the limitation of the current posterior approach. Laminectomy was often not effective when posterior osteophytes compress the nerve root in the intervertebral foramen. Furthermore if the radicular pain was bilateral, bilateral facet excision was necessary to adequately decompress the nerve roots by a posterior approach, often leading to instability. They reported the following benefits of ACDF for the treatment of radiculopathy that this operation: 1) has less morbidity than laminectomy, 2) can remove disc pathology without distrubing spinal canal, 3) allows interbody fusion of the cervical spine at the specific intervertebral level from which symptom arise. In November of the same year, Cloward [4] reported interbody arthrodesis by using dowel type graft. It applied Wiltberger's lumbar interbody dowel fusion technique on cervical spine, and unlike Smith-Robinson technique, it removed not only discs but also all lesions that compressing the neural structure anteriorly under direct visualization, and used a large drill to prepare the area for bone graft. They showed the result that 42 cases out of 47 cases had a complete relief, and 5 cases had a partial relief, and more rapid symptomatic recovery was achieved than in cervical laminectomy. Bailey and Badgley [5] reported the technique with slot or trough type graft. This technique was originally attempted to remove tumor on cervical spine. They did not attempt to decompress neural structure directly or restore the disc height, instead they only conducted fusion with an onlay graft. They recommend 6 weeks of postoperative traction on a Stryker frame followed by immobilization in a brace for 4-6 months. This technique is not used today for single level disease, but this concept led to the development of the grafting technique after the corpectomy. In 1969, Simmons and Bhalla [6] reported anterior fusion by using keystone graft, and in 1981, Bloom and Raney [7] modified Smith-Robinson technique and inserted the horseshoe type graft in the reversed way so that cortical portion headed to disc space, so it could be stronger to resist compressive force. Since then a numerous modifications were introduced by many surgeons, and subsequent excellent results were reported so that anterior approach became the treatment of choice for cervical radiculopathy (Fig. 1).


Current concepts of anterior cervical discectomy and fusion: a review of literature.

Song KJ, Choi BY - Asian Spine J (2014)

Autogenous bone graft techniques. (A) Smith-Robinson graft (horseshoe). (B) Cloward graft (dowel). (C) Bailey-Badgley graft (onlay strut). (D) Simmons-Bhalla graft (keystone).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150000&req=5

Figure 1: Autogenous bone graft techniques. (A) Smith-Robinson graft (horseshoe). (B) Cloward graft (dowel). (C) Bailey-Badgley graft (onlay strut). (D) Simmons-Bhalla graft (keystone).
Mentions: Anterior cervical approach which is familiar to the spine surgeon was initially described by Lahey and Warren [2] to expose esophageal diverticula. Smith and Robinson [3] first applied this approach to cervical spine and reported the result of anterior cervical interbody fusion by using a horseshoe-shaped graft harvested from iliac crest in 14 patients suffering from radiculopathy. At that time there was no attempt to remove the structure compressing neural structure and simply disc was removed and autologous bone graft was filled in the hollow space to conduct the fusion. They expected that the inserted graft will indirectly decompress nerve root by recovering the disc height, and it was thought that existing osteophytes would regress wtith stabilization of the involved motion segment. Consequently, 9 patients had excellent and 4 patients had good or fair results. The reason that anterior cervical fusion came to the fore, was that the effort for overcoming the limitation of the current posterior approach. Laminectomy was often not effective when posterior osteophytes compress the nerve root in the intervertebral foramen. Furthermore if the radicular pain was bilateral, bilateral facet excision was necessary to adequately decompress the nerve roots by a posterior approach, often leading to instability. They reported the following benefits of ACDF for the treatment of radiculopathy that this operation: 1) has less morbidity than laminectomy, 2) can remove disc pathology without distrubing spinal canal, 3) allows interbody fusion of the cervical spine at the specific intervertebral level from which symptom arise. In November of the same year, Cloward [4] reported interbody arthrodesis by using dowel type graft. It applied Wiltberger's lumbar interbody dowel fusion technique on cervical spine, and unlike Smith-Robinson technique, it removed not only discs but also all lesions that compressing the neural structure anteriorly under direct visualization, and used a large drill to prepare the area for bone graft. They showed the result that 42 cases out of 47 cases had a complete relief, and 5 cases had a partial relief, and more rapid symptomatic recovery was achieved than in cervical laminectomy. Bailey and Badgley [5] reported the technique with slot or trough type graft. This technique was originally attempted to remove tumor on cervical spine. They did not attempt to decompress neural structure directly or restore the disc height, instead they only conducted fusion with an onlay graft. They recommend 6 weeks of postoperative traction on a Stryker frame followed by immobilization in a brace for 4-6 months. This technique is not used today for single level disease, but this concept led to the development of the grafting technique after the corpectomy. In 1969, Simmons and Bhalla [6] reported anterior fusion by using keystone graft, and in 1981, Bloom and Raney [7] modified Smith-Robinson technique and inserted the horseshoe type graft in the reversed way so that cortical portion headed to disc space, so it could be stronger to resist compressive force. Since then a numerous modifications were introduced by many surgeons, and subsequent excellent results were reported so that anterior approach became the treatment of choice for cervical radiculopathy (Fig. 1).

Bottom Line: Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported.To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established.Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Biomedical Science Institute, Chonbuk National University Medical School, Jeonju, Korea.

ABSTRACT
Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported. To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established. Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

No MeSH data available.


Related in: MedlinePlus