Summary
The complications of anterior discectomy without fusion were analyzed on the basis of 450 consecutive cases treated surgically for degenerative disc disease. There was no death related to the procedure. The most common complication was a worsening of the preexisting myelopathy. This occurred in 3.3%, including one case with severe medullary contusion. Wound infection developed in 1.6%. Additional radicular symptoms and wound haematoma, respectively, occurred in 1.3%; recurrent nerve palsy, Horner's syndrome, and respiratory insufficiency, respectively, in 1.1% of the cases. Epidural haematoma and instability of the cervical spine, respectively, occurred in 0.9%, nerve root lesion and aseptic spondylodiscitis, respectively, in 0.4%. There was one case each (0.2%) with a pharyngeal lesion, meningitis due to dural perforation, transient additional myelopathy, and epidural abscess.
The results and the management of complications are discussed in relation to numerous previously published reports, including posterior procedures and anterior fusion techniques. Precise knowledge of all potential accidents and pitfalls related to the surgical procedure and of their aetiology may contribute to preventing failures. The rate of complications in this series has been reduced in the past years by better patient selection, by paying more attention to correct positioning of the patient during the operation, and by meticulous removal of all offending structures. Discectomy without interbody fusion is now considered to be a reasonably safe procedure with an acceptable operative morbidity and lack of mortality.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Aronson N, Bagan M, Filtzer DL (1970) Results of using the Smith-Robinson approach for herniated and extruded cervical discs. Technical note. J Neurosurg 32: 721–722
Bailey RW, Badgley CE (1960) Stabilization of the cervical spine by anterior fusion. J Bone Joint Surg 42-A: 565–594
Benini A, Krayenbühl H, Brüderl R (1982) Anterior cervical discectomy without fusion. Microsurgical technique. Acta Neurochir (Wien) 61: 105–110
Bertalanffy H, Eggert H-R (1988) Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases. Acta Neurochir (Wien) 90: 127–135
Bertalanffy H, Eggert H-R, Gilsbach J (1988) Langzeitergebnisse nach fusionsloser zervikaler Bandscheibenoperation (Diskektomie) unter besonderer Berücksichtigung einiger arbeitsmedizinischer Aspekte. In: Hohmann D, Kügelgen B, Liebig K (eds) Neuroorthopädie 4. Springer, Berlin Heidelberg New York London Paris Tokyo, pp 393–397
Bertalanffy H, Eggert H-R (1989) Anterior discectomy without fusion for treatment of cervical degenerative disc disease. Twelve years' experience based on 450 consecutive cases. In: Louis R, Weidner A (eds) Cervical spine II. Marseille 1988. Springer, Wien New York (in press)
Bollati A, Galli G, Gandolfini M, Marini G, Gatta G (1983) Microsurgical anterior cervical disk removal without interbody fusion. Surg Neurol 19: 329–333
Breig A, Turnbull I, Hassler O (1966) Effects of mechanical stresses on the spinal cord in cervical spondylosis. A study on fresh cadaver material. J Neurosurg 25: 45–56
Busch G (1978) Anterior fusion for cervical spondylosis. J Neurol 219: 117–126
Casotto A, Buoncristiani P (1981) Posterior approach in cervical spondylotic myeloradiculopathy. Acta Neurochir (Wien) 57: 275–285
Caspar W (1987) Anterior stabilization with the trapezial osteosynthetic plate technique in cervical spine injuries. In: Kehr P, Weidner A (eds) Cervical spine I. Strasbourg 1985. Springer, Wien New York, pp 198–204
Clark K (1982) Anterior operative approach for benign extradural cervical lesions. In: Youmans JR (ed) Neurological surgery, Vol 3. W. B. Saunders Company, Philadelphia London Toronto Mexico City Sydney Tokyo, pp 2613–2628
Cloward RB (1971) Complications of anterior cervical disc operation and their treatment. Surgery 69: 175–182
Cloward RB (1962) New method of diagnosis and treatment of cervical disc disease. Clin Neurosurg 8: 93–132
Cloward RB (1958) The anterior approach for removal of ruptured cervical discs. J Neurosurg 15: 602–617
Conolly ES, Seymour RJ, Adams JE (1965) Clinical evaluation of anterior cervical fusion for degenerative cervical disc disease. J Neurosurg 23: 431–437
Cosgrove GR, Théron J (1987) Vertebral arteriovenous fistula following anterior cervical spine surgery. Report of two cases. J Neurosurg 66: 297–299
Crandall PH, Batzdorf U (1966) Cervical spondylotic myelopathy. J Neurosurg 25: 57–66
Crock HV (1983) Practice of spinal surgery. Springer, Wien New York
Cuatico W (1981) Anterior cervical discectomy without interbody fusion. An analysis of 81 cases. Acta Neurochir (Wien) 57: 269–274
DePalma AF, Rothmann RH, Lewinnek GE, Canale ST (1972) Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet 134: 755–758
Dohn DF (1966) Anterior interbody fusion for treatment of cervical-disc conditions. JAMA 197: 897–900
Dunsker SB (1976) Anterior cervical discectomy with and without fusion. Clin Neurosurg 24: 516–521
Eaton LM, Lambert EH (1957) Electromyography and electric stimulation of nerves in diseases of motor unit. JAMA 163: 1117–1124
Epstein JA, Carras R, Lavine LS, Epstein BS (1969) The importance of removing osteophytes as part of the surgical treatment of myeloradiculopathy in cervical spondylosis. J Neurosurg 30: 219–226
Espersen JO, Buhl M, Eriksen EF, Fode K, Klaerke A, Kroyer L, Lindeberg H, Madsen CB, Strange P, Wohlert L (1984) Treatment of cervical disc disease using Cloward's technique. I. General results, effect of different operative methods and complications in 1,106 patients. Acta Neurochir (Wien) 70: 97–114
Fager CA (1973) Results of adequate posterior decompression in the relief of spondylotic cervical myelopathy. J Neurosurg 38: 684–692
Flynn TB (1979) Myelopathy following anterior cervical discectomy and fusion: A case report and discussion of recent literature. Neurosurg 4: 550
Giombini S, Solero CL (1980) Considerations on 100 anterior cervical discectomies without fusion. In: Grote W, Brock M, Clar HE, Klinger M, Nau HE (eds) Advances in neurosurgery, vol 8. Springer, Berlin Heidelberg New York, pp 302–307
Goymann V, Thümler P, Thomé U (1983) Ergebnisse und Komplikationen bei über 200 Robinson-Fusionen. In: Bauer R (ed) Der vordere Zugang zur Wirbelsäule. Indikationen, Ergebnisse, Komplikationen. Thieme, Stuttgart New York, pp 3–6
Granata F, Taglialatela G, Graziussi G, Avella F, Terraccciano AM (1981) Management of cervical disk protrusions by anterior discectomy without fusion. J Neurosurg Sci 25: 231–234
Gros C, Privat JM, Safdari H (1984) Exérèse discale sans greffe dans le traitement des cervico-brachialgies. Acta Orthop Belg 50: 33–38
Grote W, Bettag W, Wüllenweber R (1970) Indikation, Technik und Ergebnisse zervikaler Fusionen. Acta Neurochir (Wien) 22: 1–27
Guarnaschelli JJ, Dzenitis AJ (1982) Anterior cervical discectomy without fusion: comparison study and follow-up. In: Brock M (ed) Modern neurosurgery 1. Springer, Berlin Heidelberg New York, pp 284–291
Guidetti B, Fortuna A (1969) Long-term results of surgical treatment of myelopathy due to cervical spondylosis. J Neurosurg 30: 714–721
Hankinson HL, Wilson CB (1975) Use of the operating microscope in anterior cervical discectomy without fusion. J Neurosurg 43: 452–456
Harms J, Heckl RW (1983) Neurologische Schädigung nach ventraler Bandscheibenoperation im Bereiche der HWS. In: Bauer R (ed) Der vordere Zugang zur Wirbelsäule. Indikation, Ergebnisse, Komplikationen. Thieme, Stuttgart New York, pp 34–36
Heiskari MJ, Rönty HS, Heikkinen ER, Nyström SHM (1979) Results of anterior and posterior approaches for removal of cervical spondylosis and herniated discs. Neurosurg Rev 2: 125–129
Henderson CM, Hennessy RG, Shuey HM Jr, Shackelford EG (1983) Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurg 13: 504–512
Hirsch C, Wickbom I, Lidström A, Rosengren K (1964) Cervical disc resection. A follow-up of myelographic and surgical procedure. J Bone Joint Surg 46 (A): 1811–1821
Hoff JT, Wilson CB (1978) Microsurgical approach to the anterior cervical spine and spinal cord. Clin Neurosurg 26: 513–528
Husag L, Probst C (1984) Microsurgical anterior approach to cervical discs. Review of 60 consecutive cases of discectomy without fusion. Acta Neurochir (Wien) 73: 229–242
Jacobs B, Krueger EG, Leivy DM (1970) Cervical spondylosis with radiculopathy. Results of anterior discectomy and interbody fusion. JAMA 211: 2135–2140
Jeffreys RV (1979) The surgical treatment of cervical spondylotic myelopathy. Acta Neurochir (Wien) 47: 293–305
Jellinger K (1980) Morphologie und Pathogenese spinaler Durchblutungsstörungen. Nervenarzt 51: 65–77
Kadoya S, Kwak S, Hirose G, Yamamoto T (1982) Cervical spondylotic myelopathy treated by a microsurgical anterior approach with or without interbody fusion. In: Brock M (ed) Modern neurosurgery 1. Springer, Berlin Heidelberg New York, pp 292–298
Karimi-Nejad A, Hamel E, Frowein RA (1981) Langzeitergebnisse der operativen Behandlung der zervikalen Bandscheibenvorfälle durch Ventralfusion. Z Orthop 119: 602–606
Kraus DR, Stauffer ES (1975) Spinal cord injury as a complication of elective anterior cervical fusion. Clin Orthop Rel Res 112: 130–141
Krayenbühl H, Weber G (1967) Zervikale Diskushernien und in den Wirbelkanal vorspringende knöcherne Randwülste. Erfahrungen mit der ventralen Operationsmethode nach Cloward. Münch Med Wschr 109: 1717–1722
Kuriloff DB, Blaugrund S, Ryan J, O'Leary P (1987) Delayed neck infection following anterior spine surgery. Laryngoscope 97: 1094–1098
Lesoin F, Bouasakao N, Clarisse J, Rousseaux M, Jomin M (1985) Results of surgical treatment of radiculomyelopathy caused by cervical arthrosis based on 1,000 operations. Surg Neurol 23: 350–355
Louis R (1983) Surgery of the spine. Springer, Berlin Heidelberg New York Tokyo
Lunsford LD, Bissonette DJ, Jannetta PJ, Sheptak PE, Zorub DS (1980) Anterior surgery for cervical disc disease. Part 1: Treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53: 1–11
Lunsford LD, Bissonette DJ, Zorub DS (1980) Anterior surgery for cervical disc disease. Part 2: Treatment of cervical spondylotic myelopathy in 32 cases. J Neurosurg 53: 12–19
Martins AN (1976) Anterior cervical discectomy with and without interbody bone graft. J Neurosurg 44: 290–295
Mayfield FH (1981) Anterior cervical discectomy with interbody fusion. In: Dunsker SB (ed) Cervical spondylosis. Raven Press, New York, pp 173–179
Modal C (1984) Cervical osteochondrosis and disc herniation. Eighteen years' use of interbody fusion by Cloward's technique in 755 cases. Acta Neurochir (Wien) 70: 207–225
Mosdal C, Overgaard J (1984) Lateral cervical facetectomy. The surgical pathology of radicular brachialgia. Acta Neurochir (Wien) 70: 199–205
Murphy MG, Gado M (1972) Anterior cervical discectomy without interbody bone graft. J Neurosurg 37: 71–74
O'Laoire SA, Thomas DGT (1983) Spinal cord compression due to prolapse of cervical intervertebral disc (herniation of nucleus pulposus). J Neurosurg 59: 847–853
Piepgras DG (1976) Posterior decompression for myelopathy due to cervical spondylosis: Laminectomy alone versus laminectomy with dentate ligament section. Clin Neurosurg 24: 508–515
Reynolds AF (1979) Epidural bleeding in anterior discectomy (Letter). J Neurosurg 50: 126
Riley LH, Robinson RA, Johnson KA, Walker AE (1969) The results of anterior interbody fusion of the cervical spine. J Neurosurg 30; 127–133
Robertson JT (1981) Anterior cervical discectomy without fusion. In: Dunsker SB (ed) Cervical spondylosis. Raven Press, New York, pp 181–190
Robinson RA, Walker AE, Ferlic DC, Wiecking DK (1962) The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg 44-A: 1569–1587
Roosen K, Grote W, Bettag W (1975) Komplikationen zervikaler ventraler Fusionsoperationen. Neurochirurgia 18: 1–11
Rosenørn J, Hansen EB, Rosenørn M-A (1983) Anterior cervical discectomy with and without fusion. A prospective study. J Neurosurg 59: 252–255
Scoville WB (1981) Posterior keyhole laminotomy: Complications. In: Dunsker SB (ed) Cervical spondylosis. Raven Press, New York, pp 169–171
Seeger W (1982) Microsurgery of the spinal cord and surrounding structures. Springer, Wien New York
Simeone FA, Rothman RH (1982) Cervical disc disease. In: Rothman RH, Simeone FA (eds) The spine. W. B. Saunders, Philadelphia London Toronto Mexico City Rio de Janeiro Sydney Tokyo, pp 440–499
Simmons EH, Wilber RG (1986) Complications of spinal surgery for discogenic disease and spondylolisthesis. In: Epps CH Jr (ed) Complications in orthopedic surgery. J. B. Lippincott, Philadelphia, pp 1200–1208
Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg 40-A: 607–624
Stoltmann HF, Blackwood W (1964) The role of the ligamenta flava in the pathogenesis of myelopathy in cervical spondylosis. Brain 87: 45–50
Sugar O (1981) Spinal cord malfunction after anterior cervical discectomy. Surg Neurol 15: 4–8
Taheri ZE, Gueramy M (1972) Experience with calf bone in cervical interbody spinal fusion. J Neurosurg 36: 67–71
Tew JM, Mayfield FH (1976) Complications of surgery of the anterior cervical spine. Clin Neurosurg 23: 424–434
Tew JM, Mayfield FH (1981) Surgery of the anterior cervical spine: Prevention of complications. In: Dunsker SB (ed) Cervical spondylosis. Raven Press, New York, pp 191–208
Thomalske G, Braunsdorf W, Galow W (1980) Ventral or dorsal surgical approach in chronic cervical myelopathies? In: Grote W, Brock M, Clar HE, Klinger M, Nau HE (eds) Advances in neurosurgery, vol 8. Springer, Berlin Heidelberg New York, pp 59–63
Tribolet N de, Zander E (1981) Anterior discectomy without fusion for the treatment of ruptured cervical discs. J Neurosurg Sci 25: 217–220
U HS, Wilson CB (1978) Postoperative epidural hematoma as a complication of anterior cervical discectomy. J Neurosurg 49: 288–291
Verbiest H, Paz Y, Geuse HD (1966) Anterolateral surgery for cervical spondylosis in cases of myelopathy or nerve-root compression. J Neurosurg 25: 611–622
Waltz TA (1967) Physical factors in the production of the myelopathy of cervical spondylosis. Brain 90: 395–404
White III AA, Southwick WO, Deponte RJ, Gainor JW, Hardy R (1973) Relief of pain by anterior cervical-spine fusion for spondylosis. J Bone Joint Surg 55-A: 525–534
Williams JL, Allen MB, Harkess JW (1968) Late results of cervical discectomy and interbody fusion: Some factors influencing the results. J Bone Joint Surg 50-A: 277–286
Wilson DH, Campbell DD (1977) Anterior cervical discectomy without bone graft. J Neurosurg 47: 551–555
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bertalanffy, H., Eggert, H.R. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta neurochir 99, 41–50 (1989). https://doi.org/10.1007/BF01407775
Issue Date:
DOI: https://doi.org/10.1007/BF01407775