Cervical Discectomy and Fusion Works

Cervical Discectomy and Fusion Works

Cervical Discectomy and Fusion Works

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The results of Anterior Cervical Discectomy and Fusion are excellent.  I find it strange that I must defend the results,  but we are in a new era of information.  Some would call it mis-information.  If you spend time researching cervical discectomy surgery,  you now see a trend where certain entities are advertising the radical nature of neck fusion.  Other sites are promoting artificial disk replacements for the neck.  Be aware that the marketers for the various entities  have introduced their bias to the discussion.

Most spine surgeons will agree that Anterior Cervical Discectomy and Fusion surgery is  the most predictable surgery performed by our specialty.  For the typical patient,  they have had significant arm pain associated with a pinched nerve in the neck.  Despite reasonable conservative care,  the pain has persisted,  or worse,  the arm has developed progressive weakness.  An MRI or CT scan will demonstrate a cervical disk herniation in a level and position that correlates well with the arm nerve pattern (radiculopathy).  Ideally,  the nerves compressed are secondary to only  one or two disk levels.  The disk herniations are such that a posterior limited foraminotomy or discectomy would not adequately address the issue. For these patients (assuming there is no medical condition that precludes surgical intervention),  Anterior Cervical Discectomy and Fusion has been the traditional,  and most effective surgical option.

Statistically,  Anterior Cervical Discectomy and Fusion surgery (ACDF) has a predictable success rate of greater than 90%.   The procedure was first utilized in the 1950’s,  and the success rates have been consistent since that time.  Success is defined by a significant reduction of the pre-operative nerve irritation, as well as reductions of the associated neck pains and cervicogenic headaches.  For most patients,  by reducing the nerve compression,  over time,  most of the nerve impairment induced weakness to the arm will recover.

By using anterior instrumentation (plates and screw fixation),  fusion of the involved segments typically occurs.  Most complications are transient in nature (hoarseness of voice,  difficulty with swallowing certain foods,  asymmetric pupil dilation, etc).

Today,  about 75% the patients do have the procedure performed as an outpatient procedure.  Most people can return back to a sedentary level of activity within a few weeks.  Heavy laborers can resume such activities within a few months.

The controversy is over the comparison of Anterior Cervical Discectomy and Fusion  with  Anterior Cervical Disectomy and Artificial Disk Replacement.    Being one of the investigators of  an artificial disk device,  I have had the opportunity to compare the results.  For the most part,  the success rates for both of the procedures were essentially the same.  Long term,  we still do not know if the artificial disk will protect the cervical spine from developing adjacent level disease, or degeneration.    And,  we must also understand the nature of these comparison studies.  Usually there is stricter criterion used on the study related patients.  As the physicians performing the procedure are under increased scrutiny,   there is more attention to details.  And yes,  usually these comparison trials are performed by higher volume centers.  As with most studies,  the results of the trials are often better than the results of the procedure used by the general public.    What  I can say is the artificial disk does seem to have some promise,  but it is still too early to definitely say it is better than the standard Anterior Cervical Discectomy and Fusion.  Long term,  I predict there will be advantages to using the artificial disks in specific patient populations.  But,  as of now, that specific patient population has not been determined.

As it stands,  Anterior Cervical Discectomy and Fusion has excellent results,  and it is still the gold standard for the situation described above.  So,  next time you see an advertisement about the radical nature of neck fusion,  or the significant advantages of artificial disk replacements of the neck,  understand you are seeing marketing bias,  without long term scientific information.

 

Citations

  • Skovrlj B, Steinberger J, Guzman JZ, Overley SC, Qureshi SA, Caridi JM, Cho SK. The 100 Most Influential Articles in Cervical Spine Surgery. Global Spine J. 2016 Feb;6(1):69-79. PubMed PMID: 26835204

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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