Anterior cervical discectomy and fusion indications


Anterior and posterior approaches are widely employed in DCM when compressive elements predominate in the anterior or posterior spinal cord, respectively. Indications for each approach remain controversial in some contexts.


Anterior cervical discectomy and fusion (ACDF), without and with cervical plate (ACDF+CP) are accepted surgical techniques for the treatment of degenerative cervical disc disorder.and cervical laminoplasty (LP) are the most commonly performed procedures for degenerative cervical spondylosis. 1) 2)

Interbody fusion is performed with bone grafts or interbody cages, and may be supplemented with anterior cervical plates.

A study demonstrates that 3- and 4-level ACDF can potentially be performed safely on an outpatient basis, allowing patients to spend less time in the hospital 3).


Once conservative treatment for cervical radiculopathy, cervical spondylotic myelopathy, or both, has failed, surgical intervention is indicated 4).

It has been shown that ACDF induces biomechanical changes leading to modifications of intradiscal pressure pressure recordings in the cervical spine 5) 6) 7) and to increased stress and motion of vertebral segments adjacent to the fused ones.

see Anterior cervical discectomy and fusion for cervical spondylotic myelopathy.


1)
Cloward RB: The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617, 1958.
2)
Robinson RA, Smith GW: Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull John Hopkins Hosp 96:223–224, 1955.
3)
Khalid SI, Kelly R, Carlton A, Adogwa O, Kim P, Ranade A, Moreno J, Maasarani S, Wu R, Melville P, Citow J. Outpatient and inpatient readmission rates of 3- and 4-level anterior cervical discectomy and fusion surgeries. J Neurosurg Spine. 2019 Mar 29:1-6. doi: 10.3171/2019.1.SPINE181019. [Epub ahead of print] PubMed PMID: 30925482.
4)
Sonntag VK, Han PP, Vishteh AG. Anterior cervical discectomy. Neurosurgery. 2001 Oct;49(4):909-12. PubMed PMID: 11564253.
5)
POSPIECH J, STOLKE D, WILKE HJ, CLAES LE. Intradiscal pressure recordings in the cervical spine. J Neu- rosurg 1999; 44: 379-385.
6)
WEINHOFFER SL, GUYER RD, HERBERT M, GRIFFITH SL. Intradiscal pressure measurements above an in- strumented fusion. A cadaveric study. Spine 1995; 20: 526-531.
7)
WIGFIELD CC, SKRZYPIEC D, JACKOWSKI A, ADAMS MA. Internal stress distribution in cervical interverte- bral discs: the influence of an artificial cervical joint and simulated anterior interbody fusion. J Spinal Disord Tech 2003; 16: 441-449.
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