Abstract
In the 40 years since Smith and Robinson described the anterior approach to decompress and fuse the cervical spine, generally acceptable clinical results have been reported though few papers include any form of detailed outcome assessment. More recently Snyder and Bernhardt have described an anterolateral disc-preserving approach to treat cervical radiculopathy that does not entail vertebral artery exposure. We describe our experience of this procedure.
Surgery was performed on 40 patients ( 21 male, 19 female, mean age 41 years). Functional outcome was assessed by the Neck Disability Index (NDI), return to usual work status, patient subjective satisfaction rating, and by standard VAS. Radiographic evaluation was performed looking at the following parameters: neutral films – maintenance of interbody disc height/diameter ratio R and degree of kyphosis/lordosis: dynamic films – degree of movement maintained at operated motion segment.
At an average follow up of 20 months(range 6 – 36) the mean NDI had fallen from 45% to 10% .Mean neck pain score was 2 (pre op was 7), average arm pain score 1 (pre op was7). 93% of patients had returned to work, 85% to their original occupation at an average of 11 weeks. Patient satisfaction scores were: 85% very satisfied, 5 % satisfied, 5% unsatisfied and 5% very unsatisfied. Radiologically it was possible to preserve intervertebral body disc height and motion in some patients whilst others lost some height and motion. A minority fused spontaneously.
ACFID is associated with clinical functional outcome scores comparable with those reported in the literature for alternative procedures. Bone graft donor site morbidity is avoided and radiological results show that preservation of useful motion at the operated disc is possible.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom.
