Current concept on the operative treatment for degenerative cervical disc disease

Taek-Soo Jeon; Han Chang; Byung-Wan Choi

doi:10.5124/jkma.2011.54.9.941

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Jeon, Chang, and Choi: Current concept on the operative treatment for degenerative cervical disc disease

Continuing Education Column

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2011; 54(9): 941-950.

Published online: 15 September 2011

DOI: https://doi.org/10.5124/jkma.2011.54.9.941

Current concept on the operative treatment for degenerative cervical disc disease

Taek-Soo Jeon, MD, Han Chang, MD, Byung-Wan Choi, MD

Spine Center, Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Corresponding author: Han Chang, chspine@korea.com

Received 3 June 2011 Accepted 17 June 2011

(open-access):

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Degenerative changes in the cervical spinal column are common in the adult population. Although most patients respond well to initial nonsurgical management, those who continue to have symptoms or patients with clinically evident myelopathy are candidates for surgical intervention. The objective of this article is to review and discuss the surgical treatment for degenerative cervical spine disease. Anterior cervical spine surgery is commonly used to treat numerous pathologic entities and is expected to increase with the development of surgical techniques and instruments. Autogenous tricortical iliac crest struts are the best option for anterior fusion, but they are associated with donor site morbidity. Equivalent fusion rates have been reported after allografting and autografting, combined with the use of anterior plates. Artificial disc replacement, one of the emerging motion-sparing technologies, is currently used and has shown excellent results. However, longer follow-up is needed to determine whether these devices can function well over time. Surgical treatments in degenerative cervical disease have shown excellent results. Appropriate methods that take into account the pathologic status of the patient and the surgeon's surgical experience can prevent complications and lead to excellent surgical outcomes.

Keywords: Herniated cervical disc, Cervical radiculopathy, Cervical myelopathy, Anterior cervical discectomy and fusion, Artificial disc replacement

Figures and Tables

Figure 1

Anterior cervical discectomy and fusion using autogenous tricortical iliac bone (arrow).

Figure 2

Anterior cervical discectomy and fusion using allogenous tricortical iliac bone.

Figure 3

Anterior cervical discectomy and fusion using polyetheretherketone cage filled with autogenous cancellous bone (A) without plate fixation, (B) additional plate fixation.

Figure 4

Anterior cervical discectomy and fusion using zero-profile implant with a stand-alone cage filled local bone.

Figure 5

Anterior transvertebral herniotomy.

Figure 6

Currently available artificial cervical disc in USA. (A) Prodisc-C, Synthes® (B) Prestige LP, Medtronic® (C) MobiC, LDR Medica® (D) Discover, DePuy® (E) M6, Spinal Kinetics® (F) ActivC, Aesculap® (G) Discovery, Scient'X® (H) Bryan, Medtronic®.

Figure 7

Postoperative plain radiographs of cervical disc replacement. Anteroposterior view (A).Flexion-extension lateral X-ray show motion at C5-6 level (B,C).

References

1. Murphy DR, Hurwitz EL, Gregory A, Clary R. A nonsurgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study. J Manipulative Physiol Ther. 2006. 29:279–287.

2. Davis H. Increasing rates of cervical and lumbar spine surgery in the United States, 1979-1990. Spine (Phila Pa 1976). 1994. 19:1117–1123.

3. Angevine PD, Arons RR, McCormick PC. National and regional rates and variation of cervical discectomy with and without anterior fusion, 1990-1999. Spine (Phila Pa 1976). 2003. 28:931–939.

4. Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am. 1993. 75:1298–1307.

5. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958. 40-A:607–624.

6. Zdeblick TA, Bohlman HH. Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting. J Bone Joint Surg Am. 1989. 71:170–182.

7. Benini A, Krayenbühl H, Brüderl R. Anterior cervical discectomy without fusion. Microsurgical technique. Acta Neurochir (Wien). 1982. 61:105–110.

8. Gore DR, Sepic SB. Anterior discectomy and fusion for painful cervical disc disease. A report of 50 patients with an average follow-up of 21 years. Spine (Phila Pa 1976). 1998. 23:2047–2051.

9. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999. 81:519–528.

10. Watters WC 3rd, Levinthal R. Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up. Spine (Phila Pa 1976). 1994. 19:2343–2347.

11. Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res. 1996. (329):300–309.

12. Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine (Phila Pa 1976). 1995. 20:1055–1060.

13. Sandhu HS. Bone morphogenetic proteins and spinal surgery. Spine (Phila Pa 1976). 2003. 28:15 Suppl. S64–S73.

14. Goldberg VM, Stevenson S. Natural history of autografts and allografts. Clin Orthop Relat Res. 1987. (225):7–16.

15. Malloy KM, Hilibrand AS. Autograft versus allograft in degenerative cervical disease. Clin Orthop Relat Res. 2002. (394):27–38.

16. Zdeblick TA, Ducker TB. The use of freeze-dried allograft bone for anterior cervical fusions. Spine (Phila Pa 1976). 1991. 16:726–729.

17. Miller LE, Block JE. Safety and effectiveness of bone allo-grafts in anterior cervical discectomy and fusion surgery. Spine (Phila Pa 1976). 2011. 02. 07. [Epub]. DOI: 10.1097/BRS.0b013e3181ff37eb.

18. Gercek E, Arlet V, Delisle J, Marchesi D. Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J. 2003. 12:513–516.

19. FDA public health notification: life-threatening complications associated with recombinant human bone morphogenetic protein in cervical spine fusion [Internet]. 2008. cited 2011 Jul 11. Silver Spring (MD): US Food and Drug Administration;Available from: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm062000.htm.

20. Bolesta MJ, Rechtine GR 2nd, Chrin AM. Three- and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study. Spine (Phila Pa 1976). 2000. 25:2040–2044.

21. Park JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am. 2005. 87:558–563.

22. Emery SE, Fisher JR, Bohlman HH. Three-level anterior cervical discectomy and fusion: radiographic and clinical results. Spine (Phila Pa 1976). 1997. 22:2622–2624.

23. Connolly PJ, Esses SI, Kostuik JP. Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates. J Spinal Disord. 1996. 9:202–206.

24. Samartzis D, Shen FH, Lyon C, Phillips M, Goldberg EJ, An HS. Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion? Spine J. 2004. 4:636–643.

25. Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976). 2009. 34:2886–2892.

26. Maurice-Williams RS, Elsmore A. Extended anterior cervical decompression without fusion: a long-term follow-up study. Br J Neurosurg. 1999. 13:474–479.

27. Noguchi K, Matsushita M. Anterior decompression for cervical spondylosis using microscope. Bessatsu Seikeigeka. 1988. 13:54–57.

28. Sakai T, Katoh S, Sairyo K, Tamura T, Hirohashi N, Higashino K, Yasui N. Anterior transvertebral herniotomy for cervical disc herniation: a long-term follow-up study. J Spinal Disord Tech. 2009. 22:408–412.

29. Heller JG, Sasso RC, Papadopoulos SM, Anderson PA, Fessler RG, Hacker RJ, Coric D, Cauthen JC, Riew DK. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976). 2009. 34:101–107.

30. Hirabayashi K, Miyakawa J, Uzawa M. Canal-expansive laminoplasty as a new method of cervical posterior decompression. Chubu Seisaishi. 1979. 22:417–419.

31. Henderson CM, Hennessy RG, Shuey HM Jr, Shackelford EG. Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. 1983. 13:504–512.

32. Hirabayashi K, Satomi K. Operative procedure and results of expansive open-door laminoplasty. Spine (Phila Pa 1976). 1988. 13:870–876.

33. Kurokawa T, Tsuyama N, Tanaka H. Enlargement of spinal canal, sagittal splitting of spinous process. Bessatsu Seikeigeka. 1982. 2:234–240.

34. Kawai S, Sunago K, Doi K, Saika M, Taguchi T. Cervical laminoplasty (Hattori's method). Procedure and follow-up results. Spine (Phila Pa 1976). 1988. 13:1245–1250.

35. Chang H, Park JB, Kim KW, Choi WS. Expansive open door laminoplasty. J Korean Soc Spine Surg. 2000. 7:497–501.

36. Chiba K, Toyama Y, Matsumoto M, Maruiwa H, Watanabe M, Hirabayashi K. Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1976). 2002. 27:2108–2115.

37. Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H. C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine (Phila Pa 1976). 2003. 28:2447–2451.

38. Tsuzuki N, Abe R, Saiki K, Zhongshi L. Extradural tethering effect as one mechanism of radiculopathy complicating posterior decompression of the cervical spinal cord. Spine (Phila Pa 1976). 1996. 21:203–211.

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