There were 55 patients (soft disc, 21 and
spondylosis, 34) who underwent anterior cervical
discectomy without fusion (ACD) using an operating microscope.
Discectomy of a single level was performed on 48 cases and two levels on 7. There were 37 patients with
radiculopathy, and 18 patients with
myelopathy or myeloradiculopathy who were followed clinically for 2-13 years postoperatively. Overall 81% of patients were improved in soft
disc herniation, and no significant differences were noted between the group of
radiculopathy and
myelopathy. In
spondylosis all but one patient reported initial relief of their preoperative symptoms; however, overall improvement was noted in only 16 patients (47%). The causes of symptomatic deterioration after ACD for
spondylosis were later symptomatic recurrence in 5 patients, severe
neck pain in 4, and development of new symptoms due to adjacent spur formation in 2. The authors eventually added interbody fusion in 4 cases. Cervical spine roentgenograms almost always showed a loss of height of the interspace and an anterior angulation immediately after ACD, but the alignment of the spine tended to improve with time, so that, at last follow-up, 82% had a good alignment. A spontaneous osseous fusion occurred in 74% of cases. An adjacent spur formation was observed in 3 patients with
spondylosis. The most troublesome complication was neck and/or scapular
pain. This
pain usually subsided spontaneously, but this continued for more than 4 years postoperatively in 4 patients with
spondylosis. Using an operating microscope ACD is a safe and effective procedure for patients with soft
disc herniation, but the authors still prefer anterior cervical
discectomy with interbody fusion for the patients with advanced
spondylosis.