Single-level Anterior Cervical Discectomy and Fusion Without Plate or Cervical Collar

There are two different commonly used surgical procedures for cervical fusion. The older method was developed in the 1950s and involves fusion from the front of the neck. This is called anterior cervical discectomy and fusion (ACDF). Most surgeons have advocated the use of a rigid collar after fusion without instrumentation. Problems associated with this surgical procedure include graft migration and nonunion. Because of these problems, some surgeons opted to perform anterior fusion with additional fixation using a plate. One of the advantages of fixation with instrumentation is that it usually eliminates the need for a rigid neck collar during the post-operative period.

The authors studied 170 patients that were able to be contacted following single-level anterior cervical fusion. The surgeon used cadaver bone graft material for the fusion. Patients were offered the option of wearing a soft cervical collar for comfort. The use of rigid cervical collar was not used Patients were encouraged to resume normal activities as soon as tolerated after surgery.

Fusion rate was determined using postoperative flexion and extension films at 12 months following surgery. Focal and segmental alignment and disc space height was evaluated using lateral Xrays.

The authors report a fusion rate of 94 percent and favorable neurological outcomes in 96 percent of patients. These outcomes are felt to be similar to those following ACDF with plate instrumentation. The authors feel that ACDF without instrumentation and without the use of a postoperative collar is feasible in treating cervical spondylosis.