Anterior cervical discectomy and fusion for the treatment of giant cervical disc herniation

Abstract

Abstract Purpose Giant cervical disc herniation (GCDH) is rarely seen in the clinical setting but can cause serious medullary symptoms. Several surgical treatment procedures have been reported to date, but each remains challenging to perform. The purpose of this study was to analyze the feasibility of anterior cervical discectomy and fusion (ACDF) for the treatment of GCDH. Methods GCDH was defined as a herniated intervertebral disc that accounted for more than 50% of the spinal canal. Patient demographic and imaging data, clinical results, and perioperative complications were analyzed retrospectively. All patients were treated with ACDF. Results A total of 23 patients were included in the study; none had spinal cord or vertebral artery injury. Spinal cord recovery pulsation was observed under a microscope in all cases. Postoperative magnetic resonance imaging showed complete decompression of the spinal cord and no residual intervertebral disc. The patients were followed up for 12 to 18 months. The average visual analogue scale score and Oswestry Disability Index decreased from 8.6 ± 0.5 and 86.0 ± 2.7% to 2.2 ± 0.2 and 26.7 ± 2.0%, respectively, three days after surgery. The average Japanese Orthopedic Association score increased from 6.9 ± 2.1 to 13.9 ± 1.1. The cervical spinal cord function improvement rate was 69.3%. No neurological complications after surgery were observed. Conclusion This study shows that ACDF is feasible for the treatment of GCDH disease. The results indicate that this approach can be used to safely remove herniated disc fragments, effectively relieve compression of the spinal cord, and improve neurological function.