Anterior Cervical Discectomy and Fusion

On Topic Video Transcript

Peter C. Gerszten, MD, MPH, FACS

Director, Percutaneous Spine Service

Anterior cervical discectomy and fusion has been the standard surgical treatment for degenerative conditions of the cervical spine for many, many years. Considerable research has demonstrated the efficacy of the procedure with plate fusion for the treatment of cervical disc herniations with very successful resolution of preoperative symptoms. The procedure is performed by making a small incision in the front of the neck, removing the diseased disc, and inserting a device in its place to maintain intervertebral disc height and encourage fusion across the vertebral bodies.

Limitations of Current Techniques

Although successful in achieving fusion, the currently employed anterior plating technique after cervical discectomy is not without complications. Dysphagia is the most common postoperative complication, and it has been linked to the anterior prominence associated with the plate and screw constructs and the adhesions that form in response to the plate. By eliminating the need for a cervical plate, a smaller incision can be used, allowing for less manipulation of the airway, the vocal cords, esophagus, and vascular structures.

Experience: First in The World

More recently, in an effort to reduce the potential complications associated with these cervical plates, surgeons have adopted techniques using a zero-profile interbody fixation device that eliminates the need for an anterior plate after a discectomy procedure. This year, at UPMC, we performed the world’s first clinical use of a next generation zero-profile device known as the Optio-C™ Anterior Cervical System. The Optio-C™ device is contained entirely within the disc space and does not protrude past the anterior wall of the vertebral body as does an anterior cervical plate. This minimizes soft tissue irritation and contact with the esophagus and vocal cords.

Better Outcomes

By eliminating the need for a cervical plate, a smaller incision can be used, allowing for less manipulation of the airway, the vocal cords, the esophagus, and vascular structures. The risk of future complications in adjacent levels of the cervical spine is also theoretically minimized, as it has been shown that cervical plates placed near an adjacent level may lead to bone formation and degeneration of that adjacent disc. This more minimally invasive approach allows for a decrease in the risk of complications and may shorten the patient’s recovery time.