Anterior cervical discectomy and fusion : a preliminary report about Duhok experience

Abstract EN

Background: Anterior cervical approach has, for many decades, been a well established and standard access to degenerative, traumatic and neoplastic cervical spine lesions achieving a substantial benefit to the patient population.

Design and Setting : This is a retrospective study encompassing twenty adult patients, who had been operated upon, “anterior cervical discectomy and fusion” at the Neurosurgical Department, the Accident and Emergency Teaching Hospital in Duhok City between April 2010 – April 2012, by the neurosurgical staff as a team approach.

The follow-up period ranged from 6 months to 2 years.

Aim of study An initial and preliminary report spreading the Duhok experience in this respect of neurosurgical practice.

Patients and methods: There were twenty adult patients, 12 males and 8 females, ages ranged from 18 – 60 years, mean 39 years and 4 months.

Diagnosis was achieved via clinical history and examination, plain cervical spine X-ray radiography, computed tomography (CT) and magnetic resonance imaging (MRI); other ancillary clinical investigations were done like neurophysiologic tests.

The surgical procedure was the standard anterior cervical discectomy with fusion.

Polyetheretherketone (PEEK) cages were used utilizing Ulrich Co.

instrumentation system aided by image intensifier localization and the use of operating microscope (Pantera of Zeiss Co.).

All patients had post-operative imaging checking.

Results: There were 16 patients with symptomatic degenerative and 4 patients with traumatic cervical spine lesions.

Post-operatively, all patients experienced various degrees of immediate relief of symptoms with marked improvement of radicular and neck pain in 93.75% of the patients with degenerative spine disease.

However, those with traumatic spinal cord injury had slow neurological recovery.

Transient complications were in form of hoarseness, swallowing difficulty and C5 pain were mild and seen in 20% of cases.

Permanent and surgical and cage related complications were not encountered.

Discussion: The indications for the surgical intervention were symptomatic degenerative cervical disc disease and spondylotic myelopathy in 16 cases (Fig.

1 and 2) and cervical spine trauma (4 cases).

The lower cervical spine segment involvement (C5-6-7 levels) was noticed in 13 (81.25%) out of 16 patients with degenerative spine disease.

Overall, single level surgery was done in 6 (30%) patients while the rest 14 (70%) patients underwent two levels surgery.

The implants included either single-level interbody cage insertion or two-levelcage insertion with, additional, plate and screws fixation.

Conclusions: It is concluded that the team neurosurgical approach to the anterior cervical pathology, in the availability of standard facilities, is very fruitful and can achieve an excellent clinical results to the patients.