Anterior decompression and fusion in cervical spondylosis

Cervical spondylosis is the most frequent reason for progressive impairment of spinal cord and nerve roots, which is clinically manifested as cervical spondylotic myelopathy (CSM), cervical radiculopathy, or both. Eighty operated patients are presented (49 men and 31 women), who had evidence of CSM and/ or radiculopathy. Age ranged from 26 to 80 years (mean 50 years). Depending on the predominating clinical symptoms the patients were divided as follows: 30 patients (25 men and 5 women) with CSM, 28 patients (7 men and 21 women) with radiculopathy, and 22 patients (17 men and 5 women) with myeloradiculopathy. The clinical evaluation in each patient was performed by the Nurick classification scale. All patients were operated through an anterior approach at different levels, and the following surgical procedures were applied: discectomy and/or osteophitectomy, followed by fusion by a carbon fiber cage, with or without anterior stabilization by a titanium plate. The post-operative evaluation and follow-up were performed in 71 patients (89%). In 64 of them (90%) progressive clinical improvement was observed. 7 of them had no change (10%). Early or late complications related to the surgical approach and the heterologic implants have not been detected so far. The choice of surgical approach in cervical spondylosis is still controversial, nevertheless, the anterior decompression and fusion have been considered appropriate in many clinical cases over the last years. Based on the results analyzed so far we advocate the anterior surgical approach and fusion by carbon fiber cage with or without titanium plaque for stabilization.