Outcome of Management of Multilevel Cervical Disc by Anterior Discectomy and Cage versus Posterior Decompression and Lateral Mass Fixation

Document Type : Original Article

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Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: Radiculopathies and cervical myelopathy are well-known complications of multilevel cervical disc degeneration. Multilevel cervical disc herniation remains a challenging condition to manage, with debate regarding the optimal surgical approach.
Aim of the work: This study aims to compare outcomes of anterior cervical discectomy and fusion [ACDF] using cage versus posterior cervical foraminotomy/laminoplasty with lateral mass fixation for multilevel cervical disc herniation.
Patients and Methods: The current Prospective comparative study was conducted on 30 cases with multilevel cervical disc at Al-Azhar university hospitals. Twenty patients [66.7%] were subjected to anterior cervical discectomy with fusion [ACDF] [Group 1], while the remaining 10 patients [33.3%] were subjected to posterior cervical discectomy with fixation [Group 2]. Clinical outcomes were assessed post-surgery. Radiographic fusion/union was also evaluated.
Results: As regards the post-operative neck pain, it was present in 40% of the patients who underwent ACDF versus 30% of the patients who underwent Posterior cervical discectomy with fixation [P = 0.5]. However, the radiculopathy was significantly higher in group 2 [50%] than group 1 [10%] postoperatively [P = 0.01]. The cord manifestations were reported only in one case in group 2.
Conclusion: Both anterior and posterior approaches are effective in management of multilevel cervical disc in radiculopathy and myelopathy with higher incidence of persistent radiculopathy in posterior approach and with higher incidence of complication like transient dysphagia, hoarseness of voice and weakness in anterior approach.

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