Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study.
Neurosurgery
; 61(1): 107-16; discussion 116-7, 2007 Jul.
Article
en En
| MEDLINE
| ID: mdl-17621025
ABSTRACT
OBJECTIVE:
The need for interbody fusion after anterior cervical discectomy for radiculopathy remains controversial. The purpose of this study was to assess clinical and radiographic outcomes in patients with cervical radiculopathy after discectomy without fusion (ACD), discectomy with intervertebral fusion (ACDF), and discectomy with intervertebral fusion and instrumentation (ACDFI).METHODS:
Forty-two consecutive patients with cervical radiculopathy who failed medical management were randomized to one of three treatment groups ACD, ACDF, or ACDFI. Indices including symptoms, work status, Short Form-36, McGill pain scores, and anteroposterior/lateral flexion/extension x-rays were obtained preoperatively and during the follow-up period.RESULTS:
There were no inter-group differences observed during the 2-year follow-up period with respect to neck pain, interscapular pain, or arm pain (P > 0.05). Short Form-36 scores demonstrated a dramatic postoperative improvement followed by further gradual improvement in both physical and mental components as well as other subscale scores in all groups during the follow-up period (P < 0.05). Fusion occurred in 67% of the ACD patients compared with 93% of the ACDF patients and 100% of the ACDFI patients (P < 0.05). Segmental kyphosis was noted in 75% of the ACD patients postoperatively compared with 17% preoperatively. There was no change in sagittal balance in the ACDF or ACDFI groups (P > 0.05).CONCLUSION:
Patient selection and surgical decompression remain the key to achieving desirable clinical outcomes after cervical discectomy for radiculopathy. Within a 2-year follow-up period, the technique of reconstruction plays no role in clinical results. However, ACD alone results in segmental kyphosis compared with ACDF and ACDFI.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Radiculopatía
/
Fusión Vertebral
/
Discectomía
/
Desplazamiento del Disco Intervertebral
Tipo de estudio:
Clinical_trials
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Neurosurgery
Año:
2007
Tipo del documento:
Article
País de afiliación:
Canadá