Aims: Presentation of modified anterior cervical discectomy by Smith- Robinson method with stabilisation by Cornerstone Carbon Cage (CCS). Methods: Since November 2001, we have been performing unique anterior intervertebral stabilisation procedures with use of carbon implants. Cornerstone Carbon Cage is an artificial intervertebral graft with empty space inside to be filled by bone chips. Cages are from 5 to 7millimetres high, with a higher anterior edge for restoration of physiological lordosis. During the operation we use typical right-side approach to vertebral column. Using intervertebral retractor we perform very wide discectomy until obtaining complete decompression of lateral recesses with exposition of joints of Luschka, which are anatomical lateral limits of the disc space. Afterwards, the wedge-shaped resection of posterior edges of the upper and lower vertebral body which are formed by osteophytes, is performed. Then, we fill the cage by bone chips and osteophytes, and using intervertebral retractor we wedge it into intervertebral space. Results: The procedure allows us to obtain the restoration of lordosis, good stabilisation of vertebral column, and additionally, through a minor distraction, procures decompression of spinal roots in intervertebral foramina. Conclusions: Through a wide intra-operational view, after discectomy and wedge-shaped resection of the vertebral body, it is possible to entirely decompress spine and nerve roots. The above modification of Smith-Robinson method creates ideal conditions for use of CCS.

Aims: Presentation and evaluation of clinical outcomes of patients with cervical degenerative disc disease treated by Smith – Robinson method with interbody fusion by Cornerstone Carbon Cage (CCS) in own clinical experience. Methods: We operated 37 patients by anterior cervical discectomy with interbody stabilisation by CCS in the last 11 months. 31 patients were operated for the first time. In 6 cases, patients were reoperated after surgical treatment in other hospitals. The Smith – Robinson cervical discectomy with anterior interbody fusion by CCS was performed in all patients. Additionally, in 12 patients titan cervical plates were used. Follow-up examinations were performed in 2 and 6 months after the treatment. Results: All treated patients experienced total pain termination. In patients with posttraumatical discopathy and heavy cervical spondylosis with ligamental instability (33% all patients) additional internal stabilisation by cervical plate was performed. Neurological or local long-term postoperative complications were not observed. Conclusions: Patients who underwent treatment by anterior cervical discectomy met. S-R with interbody stabilisation by CCS benefited from the treatment and present good clinical outcome with pain termination and gradual disappearance of neurological disabilities. Using of cornerstone carbon cage allows to obtain good stabilisation without the necessity of allogenic bone graft insertion. This kind of stabilisation is sufficient without external collar stabilisation.

Aims: The Attempt to lay down indications for simultaneous applications Cornerstone Carbon Cage (CCS) and titanium plate in surgical treatment of cervical spondylosis with ligamental instability. Methods: Between November 2001 and august 2002 13 patient with ligamental instability underwent applications CCS and cervical plate during one ormultilevel cervical discectomy due to degenerative or posttraumatic cervical spondylosis. We never used external þxation. Results: There were no complications after operations. Preoperative symptoms withdrew in all patient. Good stabilisation was obtained in whole operated group. Conclusions: Simultaneous applications CCS and cervical plate is an effective method in surgical treatment cervical spondylosis with ligament instability. Appropriate stabilisation was obtained without additional external collar þxations and without necessity of autogenic bone graft.