gms | German Medical Science

Objective: Conventional anterior cervical discectomy and fusion (ACDF) surgery is the treatment of choice for cervical radiculopathies caused by herniated cervical disc (HCD) or foraminal stenosis (FS). But neck motion limitation after multilevel ACDF and/or corpectomy & reconstruction would not be avoidable, and axial neck is also considerable. Moreover development of adjacent level degeneration after ACDF still requires further improvement. For preserving the motion of spinal motion segment, artificial disc transplantation was revolutionary developed, but all of these prosthesis still did not reached to human disc motion, and cause many complications. Then anterior cervical microforaminodiscectomy (ACMFD) which is one of non-fusion surgical technique is applicable method in combination with fusion surgery on multilevel radiculopathy. The purpose of this study is to introduce alternative surgical technique for minimizing fusion surgery on cases of multilevel cervical radiculopathies as possible.

Method: Patients with bilateral or unilaterally dominant upper extremity radiculopathies, who was defined multilevel pathologies such as HCD or FS on image studies, and underwent ACMFD combined with ACDF or corpectomy & reconstruction in other levels between Dec. 2010 and Dec 2013 were included. There were 3 females and 15 males with mean age of 57 years. Total number of fusions were 31 disc levels including ACDF(17 disc levels) and corpectomy & reconstruction (14 disc levels) and total number of ACMFD were 22 disc levels with 1 level was approached by transuncal and transcorporeal trajectories simultaneously. Combination surgical techniques were 1 level ACDF and 1 level ACMFD is 7 cases, 1 level ACDF and 2 level ACMFD is 1 cases, 2 level ACDF and 1 level ACMFD is 1 case, 2 level ACDF and 2 level ACMFD is 1 case, 3 level ACDF and 1 level ACMFD is 1 case, 1 level corpectomy and 1 level ACMFD is 4 case, 1 level corpectomy and 2 level ACMFD is 2 case, and 2 level ACDF and 1 level corpectomy and 1 level ACMFD is 1 case. Pre- and post-operative arm, shoulder and neck pain were evaluated by Visual Analogue Scale (VAS). Functional outcomes were evaluated using Neck Disability Index (NDI).

Results: Arm and shoulder pain relief was assessed by Visual analogue scale (VAS) postoperative immediately and 2,4,6 months after procedure. Early post-operatively there was significant improvement in VAS arm pain (p<0.0001). After one year there was also significant improvement in VAS neck pain (p=0.001), and VAS arm pain (p<0.0001, p = 0.001, respectively). The functional outcome was measured by Neck disability index(NDI) and relatively good in almost. Major complications such as recurrence of HCD, instrumental failure or fusion failure were not found, but non-symptomatic vertebral body compression fracture was developed between zero-P and corpectomy & reconstruction level in 1 osteoporosis patient case, and related reoperations were absent in all cases at this study periods.

Conclusions: To minimize fusion levels hybrid surgery such as anterior cervical microforaminodiscectomy combination with ACDF and/or corpectomy and reconstruction is an effective technique for treatment of multilevel degenerative radiculopathies. More cases and long-term follow-up are required for establishing spinal stability.