Current Concept on the Surgical Treatment by Anterior Approach in Degenerative Cervical Radiculopathy

Byung-Wan Choi; Kyung-Jin Song

doi:10.4184/jkss.2011.18.1.34

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Choi and Song: Current Concept on the Surgical Treatment by Anterior Approach in Degenerative Cervical Radiculopathy

Review Article

Journal of Korean Spine Surg 2011;18(1):34-41.

Published online: 21 March 2011

DOI: https://doi.org/10.4184/jkss.2011.18.1.34

Current Concept on the Surgical Treatment by Anterior Approach in Degenerative Cervical Radiculopathy

Byung-Wan Choi, M.D., Kyung-Jin Song, M.D.^∗

Department of Orthopedic Surgery, Inje University, Haeundae Paik Hospital, Busan, Korea

^∗Departments of Orthopedic Surgery, Chonbuk National University Hospital, Jeonju, Korea

Corresponding author: Kyung-Jin Song, M.D. Department of Orthopedic Surgery, Chonbuk National University Hospital, School of Medicine of Chonbuk National University, 634-18, Geum-am Dong, Duk-jin Gu, Jeonju, Korea TEL: 82-63-250-1770, FAX: 82-63-271-6538 E-mail: kysong@jbnu.ac.kr

Received 26 February 2011 Revised 27 February 2011 Accepted 28 February 2011

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

Study Design

A review of the literature regarding anterior cervical surgery in degenerative cervical radiculopathy.

Objectives

To review and discuss anterior cervical spine surgery.

Summary of Literature Review

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. Nevertheless, there is some controversy.

Materials and Methods

Literatures review.

Results

Surgical treatments using the anterior approach in degenerative cervical disease have shown excellent results. A range of techniques using plate augmentation and artificial disc replacement are now accepted as effective methods.

Conclusions

The appropriate method considering the pathologic status of the patient and surgeon's surgical experience can prevent complications and lead to excellent surgical outcomes.

Keywords: Degenerative cervical radiculopathy, Anterior approach, Clinical outcome

REFERENCES

1. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994; 117:325–35.

2. Salemi G, Savettieri G, Meneghini F, et al. Prevalence of cervical spondylotic radiculopathy: a door-to-door survey in a Sicilian municipality. Acta Neurol Scand. 1996; 93:184–8.

3. 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.

4. Davis H. Increasing rates of cervical and lumbar spine surgery in the United States, 1979-1990. Spine (Phila Pa 1976). 1994; 19:1117–23.

5. Angevine PD, Arons RR, McCormick PC. National and regional rates and variation of cervical discectomy with and without anterior fusion, 1990-1999. Spine. 2003; 28:931–40.

6. Albert TJ, Murrell SE. Surgical management of cervical radiculopathy. J Am Acad Orthop Surg. 1999; 7:368–76.

7. Wirth FP, Dowd GC, Sanders HF, Wirth C. Cervical discectomy. A prospective analysis of three operative techniques. Surg Neurol. 2000; 53:340–8.

8. Herkowitz HN, Kurz LT, Overholt DP. Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine. 1990; 15:1026–30.

9. Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955; 96:223–4.

10. Jung A, Schramm J. How to reduce recurrent laryngeal nerve palsy in anterior cervical spine surgery: a prospective observational study. Neurosurgery. 2010; 67:10–5.

11. Bertalanffy H, Eggert HR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien). 1989; 99:41–50.

12. Humphreys SC, Hodges SD, Fisher DL, Eck JC, Covington LA. Reliability of magnetic resonance imaging in predicting disc material posterior to the posterior longitudinal ligament in the cervical spine: A prospective study. Spine. 1998; 23:2468–71.

13. Connolly ES, Seymour RJ, Adams JE. Clinical evaluation of anterior cervical fusion for degenerative cervical disc disease. J Neurosurg. 1965; 23:431–7.

14. Stevens JM, Clifton AG, Whitear P. Appearances of posterior osteophytes after sound anterior interbody fusion in the cervical spine: a high-definition computed myelographic study. Neuroradiology. 1993; 35:227–8.

15. Shen FH, Samartzis D, Khanna N, Goldberg EJ, An HS. Comparison of clinical and radiographic outcome in instrumented anterior cervical discectomy and fusion with or without direct uncovertebral joint decompression. Spine J. 2004; 4:629–35.

16. Albert TJ, Smith MD, Bressler E, Johnson LJ. An in vivo analysis of the dimensional changes of the neuroforamen after anterior cervical diskectomy and fusion: a radiologic investigation. J Spinal Disord. 1997; 10:229–33.

17. Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine. 1995; 20:1055–60.

18. Hacker RJ, Cauthen JC, Gilbert TJ, et al. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine. 2000; 25:2646–55.

19. Frederic S, Benedict R, Payer M. Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single level disc herniation: a prospective comparative study. J Neurosurg Spine. 2006; 4:292–9.

20. Sekerci Z, Ugur A, Ergun R, Sanli M. Early changes in the cervical foraminal area after anterior interbody fusion with polyetheretherketone (PEEK) cage containing synthetic bone particulate: a prospective study of 20 cases. Neurol Res. 2006; 28:568–71.

21. Deutsch H, Haid RW, Rodts G, Mummaneni PV. The decision-making process: allograft versus autograft. Neurosurgery. 2007; 60:S98–S102.

22. Gercek E, Arlet V, Delisle J, Marchesi D. Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J. 2003; 12:513–6.

23. US Food and Drug Administration. FDA public health notification: life-threatening complications associated with recombinant human bone morphogenetic protein in cervical spine fusion. 2008 Jul 1.

24. Bolesta MJ, Rechtine GR 2nd, Chrin AM. Three-and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study. Spine. 2000; 25:2040–4.

25. Emery SE, Fisher JR, Bohlman HH. Three-level anterior cervical discectomy and fusion: radiographic and clinical results. Spine. 1997; 22:2622–4.

26. Song KJ, Choi BW, Kim KH, Lee KB. Anterior Cervical Fusion with Autogenous Iliac Bone Graft with or without Plate Fixation for Degenerative Cervical Spinal Disorders. J Korean Orthop Assoc. 2008; 43:338–46.

27. Song KJ, Lee KB. A preliminary study of the use of cage and plating for single-segment fusion in degenerative cervical spine disease. J Clin Neurosci. 2006; 13:181–7.

28. Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine. 2009; 34:2886–92.

29. Coric D, Finger F, Boltes P. Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site. J Neurosurg Spine. 2006; 4:31–5.

30. Sasso RC, Hacker R, Heller JG. Artificial disc versus fusion: A prospective, randomized study with 2-year followup on 99 patients. Read at the 34th Annual Meeting of the Cervical Spine Research Society. 2007; 15:2933–40.

31. Garrido BJ, Taha TA, Sasso RC. Clinical outcomes of Bryan cervical disc arthroplasty a prospective, randomized, controlled, single site trial with 48-month followup. J Spinal Disord Tech. 2010; 23:367–71.

32. Buchowski JM, Anderson PA, Sekhon L, Riew KD. Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. Surgical technique. J Bone Joint Surg Am. 2009; 91(Suppl 2):223–32.

33. Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine. 2002; 27:2431–4.

34. Park DH, Ramakrishnan P, Cho TH, et al. Effect of lower two-level anterior cervical fusion on the superior adjacent level. J Neurosurg Spine. 2007; 7:336–40.

35. Rao RD, Wang M, McGrady LM, Perlewitz TJ, David KS. Does anterior plating of the cervical spine predispose to adjacent segment changes? Spine (Phila Pa 1976). 2005; 30:2788–92.

36. 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; 81:519–28.

37. Song KJ, Choi BW. Adjacent segment degenerative disease; Is it due to disease progression or a fusion-associated phenomenon? Presented at the Eurospine. 2010;September 15-17. Vienna, Austria.

38. Herkowitz HN, Kurz LT, Overholt DP. Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine. 1990; 15:1026–30.

39. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine. 2002; 27:2453–8.

40. Fogel GR, McDonnell MF. Surgical treatment of dysphagia after anterior cervical Interbody fusion. Spine J. 2005; 5:140–4.

41. Song KJ, Kim KH, Park JH, Lee JM. Esophageal fistula formation by metal loosening following anterior cervical arthrodesis. -A case report-. J Korean Orthop Assoc. 2007; 42:404–9.

Fig. 1.

Thirty-eight-year-old female status post ACDF-CA at C5–C6, (A) postoperative plain lateral radiograph; (B, C) plain lateral radiograph 2 years postsurgery showing anterior migration of cage approximately 40 however, bony fusion developed outside the cage in the posterior intervertebral disc space.

Fig. 2.

A 54-year old man with the clinical symptoms of posterior neck pain and right radiculopathy (A) Preoperative MRI of C4-5 showed right side foraminal stenosis. (B) Preoperative MRI of C5-6 showed both side foraminal stenosis. (C,D,E) AP and lateral roentgenogram of flexion/extension views two years after surgery with hybrid pattern. There was no recurrence of preoperative radiculopathy

Fig. 3.

A 63 year old female patient with neck pain and left radicular pain had postoperative swelling with severe dyspnea. (A) Preoperative 1. plain lateral radiograph and 2-3. MRI shows left foraminal disc extrusion on C5-6. (B) Serial postoperative radiographs shows 1. immediate lateral radiograph. 2. Eight hours after operation. 3. Twenty-four hours after operation. (C) 1. Two days after operation. 2. Seven days after operation. 3. Two weeks after surgery shows decreased soft tissue swelling. 4. Six weeks after operation swelling completely subsided without dyspnea and dysphagia.

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