Extended anterior cervical discectomy without fusion: a simple and sufficient operation for most cases of cervical degenerative disease

Of 291 operations performed for cervical degenerative disease causing cord or root involvement over a 12-year period 187 have been treated by extended anterior discectomy without fusion, removing bone on either side of the posterior disc space so as to give a wide exposure of the anterior spinal and root dura. The technique has been used for 73% of the cases operated on in the last four years. Nine patients (4.8%) required an additional posterior decompression for coexisting spinal or root canal stenosis. By the first postoperative follow-up at 2-4 months 94.5% of patients showed clear neurological or functional improvement, 3% were worse and 1.5% had died (the deaths were in elderly patients with severe myelopathy and intercurrent disease). Minor treatable complications occurred in 3.2%. Only two patients (1%) complained of persistent postoperative neck pain. Patients were mobilized immediately after surgery without a collar and most left hospital within 1-4 days. A single level decompression was sufficient in 92% of patients and only one patient required more than two levels to be decompressed. In 79% of cases soft disc protrusions contributed to the compression while in 21% osteophytes alone caused the compression. We believe that this simple technique is a sufficient surgical treatment for the majority of cases of cervical degenerative disease. It does not require a fusion and avoids the specific problems and complications associated with Cloward type operations. We are engaged at present in a long-term follow up study of these patients, but to date no late problems have become apparent.