Anterior approach to the cervical spine for treatment of spondylosis or disc herniation: Long-term results. Comparison between ACD, ACDF, TDR.

BACKGROUND AND AIM Many surgical techniques are used for the treatment of cervical myelopathy and radiculopathy due to spondylosis or disc herniation. The aim of this article is to evaluate and to compare the long term outcomes of 1. anterior cervical discectomy (ACD), 2. anterior cervical discectomy with fusion (ACDF) and 3. anterior cervical discectomy with total disc replacement (TDR) in order to find the most appropriate surgical option according to the medical condition of the patient. MATERIALS AND METHODS Three retrospective cohort studies were performed to assess the long-term results of ACD, ACDF and TDR procedures. Data from the three studies were compared by statistical methods to highlight the differences in results. RESULTS All patients presented a neurological improvement that endures. The results of three surgical techniques were different as regards the alignment of the cervical spine, the preservation of mobility and the pathology of adjacent space. CONCLUSIONS TDR is the most appropriate technique in young patients, below the age of 55 years and whose pathology is prevalently a hernia. The best surgical choice is ACDF in patients above the age of 55 years and in all those cases in which there is a prevalence of spondyloarthrotic alterations. In highly selected cases, in which the cervical spine is in a flattened condition and the intervertebral space is very restricted ACD, according to Hirsh, is a surgical method which ensures a very high degree of spinal motility preservation.