The Results of Anterior Interbody Fusion of the Cervical Spine

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Abstract

In this study of the results of anterior interbody cervical-spine fusion for chronic neck pain due to disc degeneration, approximately 73 per cent of the fifty-five patients evaluated were markedly benefited two to seventy-three months after operation. Those patients with disease localized to one or two interspaces would appear to be best suited for this operation. Ninety-four per cent of the patients with only one interspace apparently involved and fused had good or excellent results, 73 per cent with two spaces involved and fused had good or excellent results, and only 50 per cent with three spaces involved and fused had good or excellent results at the time of follow-up.

The fusion rate was approximately 88 per cent (ninety-five of 108 interspaces fused).

The distance between the vertebral bodies fused by the anterior bone block was better maintained postoperatively after we started preserving the subchondral bone plates as bearing surfaces for the graft.

Postoperative changes in the bone spurs could be evaluated at the time of follow-up in half of the cervical spines of which comparable roentgenograms before and after operation were available. Half of these spines showed unequivocal evidence of remodeling and blunting of the spurs at the sites of solid intervertebral fusion, but complete resorption of the spurs was not observed.

Fusion of the involved intervertebral space has given partial or complete relief of pain in a large majority of the patients operated on. Some of these patients had an anterior cervical-spine fusion following a posterior decompression operation. The two procedures were performed because posterior decompression may relieve nerve-root or cord pressure when such pressure is obvious and severe. But this procedure by itself does not prevent the further formation of spurs or the motion of these spurs which may irritate adjacent soft tissues; neither does it eliminate the diseased intervertebral disc which may in some way be the cause of referred pain to the head, neck, shoulders, arms, hands, and chest. Depression of reflexes and partial muscle weakness were not considered sufficient evidence of nerve-root compression to require decompression by the posterior approach.

In all, disc removal and anterior intervertebral fusion was carried out on 108 interspaces in fifty-six patients with no operative deaths and only ten temporary complications. Almost all of these complications, which were previously reported, occurred in the first fourteen patients.

When other treatment seems impractical, anterior interbody fusion appears to be good surgical treatment for degenerative joint and disc disease of the cervical spine.

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