Re: anterior cervical disc surgery

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Posted by ccf neuro M.D. on May 01, 1997 at 19:52:51:

In Reply to: anterior cervical disc surgery posted by Margaret M. on April 24, 1997 at 11:14:47:

: I have had radiculopathy for almost one year in my arm
and hand. MRI shows two herniated discs (C4-5&5-6). My
neurosurgeon wants to do an anterior discectomy with
fusion. He says it's a three month recovery in a hard
collar. I have three questions:
1)Is there any facility that does microsurgery for this
problem? I have read that it is less invasive and
therefore, recovery time is reduced.
2)Is anterior disc surgery without fusion as effective
as surgery with fusion?
3)I am concerned about the complications of using my
bone (additional surgery) or banked bone
(incompatibility); is there a lesser of two evils here?
Better yet, is there another material being developed?

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Anterior cervical discectomy with fusion (ACDF) is the treatment of choice for most cases of herniated cervical disc. Microsurgery can be done on many cases, meaning that the case is done using the operative microscope. Generally, fusing the vertebrae on either side of the removed herniated disk is done, as this prevents instability from developing at the operated levels of the cervical spine. Such instability may not be immediately apparent postoperatively and end up developing months to years later, resulting in slippage of the vertebrae on each other causing compression of the spinal cord. There is a simpler posterior surgery where the lamina or roof of the vertebral body(ies) are removed and as much disk material taken out as possible, however, bone grafting is not an option with this procedure and the long term risk of instability is present. Complications of bone removal are mostly pain in the hip, where the bone is most typically harvested from. This is often worse than the neck incision pain!!! The hard collar is necessary to allow the bone to grow and fuse the vertebrae together in proper, precise alignment. This time period is independent of incicion size or specific microsurgical vs. non- technique, although microdiskectomy does generally produce a smaller incision. Although artificial materials like bone cements do exist, they are not as durable or as well liked by your body as good old bone. The bone can be your own (autologous) or, believe it or not, from a cadaver (via bone bank). Odds of fusion are slightly better with your own, but pain is obviously greater. Any large teaching institution should be able to do microdiskectomy for you--- chances are your own neurosurgeon can too. At any rate, if you've had two years radiculopathy from your disks, it definitely sounds like its time to get rid of them!!! Good Luck. If you are near Cleveland, our spinal neurosurgeon at the Cleveland Clinic is Dr. Ian Kalfas whose appointment office can be reached at 216-444-5672.

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