Patients (age 18-65 years) presenting with radicular signs due to single level cervical disc herniation lasting more than eight weeks are included. Patients will be randomised into three groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at two and five years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which three surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for two years. The follow-up period is five years.
(A) Anterior cervical discectomy (ACD)
All patients will be positioned supine with their neck in neutral position or slightly extended under general anaesthesia. The affected cervical disc level will be verified with fluoroscopy. A small transverse incision will be made either on the right side or the left side depending on the surgeon’s preference. Medial to the carotic sheath, the pre-vertebral space will be opened and the anterior cervical spine will be exposed. Two distraction pins and the Caspar spreader will be placed in the affected segment. A standard anterior discectomy with the aid of microscope or loupe/headlight magnification (depending on the surgeon’s preference) will be performed in all cases. The posterior longitudinal ligament will be opened and the nerve root and dura will be decompressed adequately. If required a vacuum drain will be placed and the wound will be closed in layers.
and 81 patients who underwent anterior cervical discectomy and …
Since the introduction of anterior approach of the cervical spine by Cloward, Robinson and Smith, a dispute has started about the best surgical treatment. The purpose of all surgical procedures is removal of the intervertebral disc in order to decompress the nerve root and alleviate radicular pain. However, cervical instability and segmental collapse with recurrent radicular pain has been documented after anterior discectomy. For this reason, most surgeons in general hospitals perform anterior discectomy with interbody fusion while most academic surgeons perform a discectomy sec as a result of lack of evidence. The results of various randomised trials suggest that interbody fusion may not be necessary in all cases. In fact, The Cochrane Review even mentioned advantages of anterior discectomy only; lower costs, shorter operation time and faster return to work10.
Other postprocedural states V45-
A Multi-Center, Prospective, Randomized, Controlled Clinical Trial Comparing the Safety and Effectiveness of the Mobi-C Prosthesis to Conventional Anterior Cervical Discectomy and Fusion in the Treatment of Symptomatic Degenerative Disc Disease in the Cervical Spine.
Dr Brian Su | Spine Surgeon San Francisco | Marin …
The study is a prospective, randomized, multi-center, concurrently controlled investigation, in which the study device will be compared to the control treatment consisting of conventional anterior cervical discectomy and fusion (ACDF) in accordance with the Smith-Robinson procedure. ACDF is defined as a complete disc removal and nerve decompression with grafting of allograft bone between the vertebrae adjacent to the degenerated disc to eliminate articulation at the damaged segment. Following discectomy and grafting, a semi-constrained, rotational anterior cervical plate will be placed. The Mobi-C cervical disc prosthesis is designed to provide an additional therapeutic option to maintain motion segment position and spacing while preserving flexibility in the affected cervical vertebral level.