Long-term Follow-up Results of Anterior Cervical Interbody Fusion with and without Cervical Plate. Comparative Study of Microdiscectomy and Automated Percutaneous Discectomy in Lumbar Disc Herniation.

Jang, Beum Ju; Haah, Eun Shin; Chi, Moon Pyo; Kim, Jae O; Kim, Jung Chul; Kim, Oui Hyun; Choi, Chang Hwa; Joo, Kyo Sung; Shin, Won Han; Kim, Bum Tae; Choi, Soon Kwan; Byun, Bark Jang

Original Article

Journal of Korean Neurosurgical Society 1997;26(4): 535-541.

Beum Ju Jang, Eun Shin Haah, Moon Pyo Chi, Jae O Kim, Jung Chul Kim, Oui Hyun Kim, Chang Hwa Choi, Kyo Sung Joo, Won Han Shin, Bum Tae Kim, Soon Kwan Choi, Bark Jang Byun

¹Department of Neurosurgery, Korea Veterans Hospital, Seoul, Korea.
²Department of Neurosurgery, College of Medicine, Soonchunhyang University, Seoul, Korea.

ABSTRACT

Eighty-four patients whose cervical lesions not associated with any trauma or tumor were operated for anterior cervical interbody fusion. The patients were separated into two groups, one group operated with a cervical plate and the other group, without the cervical plate. The mean follow-up duration in anterior cervical interbody fusion with cervical plate cases was 16 months(from 6 months to 30 months), without cervical plate 35 months(from 6 months to 84 months). Retrospective analysis of the two groups were done in order to compare the incidence of postoperative complications, clinical outcome, and radiological changes. The most notable postoperative complications of the group operated without the cervical plate were migration of the bone graft(3.3%) and angulation(3.3%), whereas of the group operated with the cervical plate were screw loosening(4.2%) and infection of the operative wound(4.2%). Comparative analysis of the postoperative clinical outcome and changes in radiological measurement of the intervertebral heights and angles showed no statistically significant difference between the two groups. The results of this study suggest that whether or not the cervical plate should be used for anterior cervical interbody fusions requires a decision made carefully and meticulously by the operator, so that the possibility of any postoperative complications can be minimized. Aretrospective study on operative results was carried out in a series of 164 patients who were performed by microdiscectomy and 57 patients by automated percutaneous lumbar discectomy(APLD) for herniated lumbar discs between January 1, 1990 and June 30, 1996. The operative results were analysed, and the correlation between preoperative clinicoradiological factors and postoperative clinical results were statistically assessed. The major results were as follows: 1) Of 164 microdiscectomy cases, 102 were males and 62 were females, mean age was 42.4 years and incidence was the highest in the 5th decade. Among 57 APLD cases, 43 were males and 14 females, mean age 32.2 years, and the highest incidence in the 3rd decade. 2) The preoperative symptoms and signs in microdiscectomy and APLD cases were lumbago(98.2% vs 98.2%), radiating pain(96.3% vs 98.2%), positive straight leg raising test(77.4% vs 70.2%), motor weakness(27.4% vs 17.5%), claudication(13.4% vs 0%) and voiding difficulty(2.4% vs 0%). 3) Number of operated levels were 226 in microdiscectomy and 74 in APLD. The most commonly operated levels in both groups were L4-5. 4) Operative results. (1) The overall success rates by Prolo's scale were 87.1% in microdiscectomy and 80.7% in APLD, respectively. (2) In younger age group(below 30 years) and in non-compensatory group, success rates were significantly higher in microdiscectomy(100%, 89.9% vs 76.7%, 62.5% respectively). (3) As to protrusion and degeneration on MRI, a clinical result, from patients with mild to moderate protrusion and degeneration of discs was significantly better in microdiscectomy group, and that of mild protrusion and degeneration of discs in APLD group was significantly better. (4) The most common cause of failure was inadequately removed disc material in microdiscectomy cases and operated for sequestered discs in APLD cases. There results indicate that there were no differance in overall success rates between microdiscectomy and APLD. But it should be emphasized that clinical results may have been influenced by age, existence of compensation, and the degree of protrusion and degeneration of discs as prognostic factors. The authors believe that if the selection of operative procedure is carefully decided with details of clinical and radiologic findings of the patients, a good outcome can be expected.

Key Words: Microvascular decompression; Teflon ring; Trigeminal neuralgia; Hemifacial spasm; Herniated lumbar disc; Microdiscectomy; Automated percutaneous lumbar disectomy(APLD)