Modified Smith-Robinson Procedure for Anterior Cervical Discectomy and Fusion
Fifty–one consecutive patients with cervical radiculopathy or spondylosis were treated with single or multilevel anterior discectomy and fusion using a modified Smith–Ribinson procedure. There were 33 single–level fusions, 16 two–level fusions, and 2 three–level fusions. The three modifications included: 1) the endplates at the fusion level were completely removed with a high–speed bur to exposed bleeding cancellous bone in parallel planes; 2) the caspar distracto (Aesculap, Burlingame, CA) was used to increase distraction and improved visualization;3) the tricortical autologous iliac crest bone graft was placed in reverse position, that is, with the cortical crosssection facting posteriorly, creating a stabilizing strut in the middle column. With an average follow–up of 1 year, the fusion rate was 94%(67 to 71 levels). The single–level fusion rate was 94%, the two–level fusion rate was 83%. Of the four nonunions, only two were symptomatic. Results by clinical examination revealed 36 (71%) excellent, 11 (21%) good, 3 (6%) satisfactory, and 1 (2%) poor outcomes. There were no significant disc collapses of extrusions. One patient had an increase in kyphotic deformity of >5°, none with > 10°,kyphosis. There were no wound infections or neurologic complications. The modified Smith–Robinson procedure for anterior cervical discectomy and fusion has led to the successful treatment of cervical radiculopathy and spondylosis with improved results and few complications.