SURGICAL-TREATMENT OF CERVICAL SOFT DISC HERNIATION - ANTERIOR VERSUSPOSTERIOR APPROACH

Purpose of the study This study is a retrospective analysis of the tre atment of cervical soft disc herniation comparing anterior and posteri or approach. Material and methods Twenty eight patients presenting wit h cervico-brachial radiculopathy secondary to acute soft posterolatera l disc herniation were reviewed. Cases with myelopathy or radiculopath y secondary to chronic spondylosis were excluded. Involved level was C 5-C6 or C6-C7 in most of cases. There were 14 females and 14 males. Ag e at operation averaged 44 years. Fourteen patients underwent an anter ior approach with discectomy and fusion using autologous iliac bone gr aft. Average age was 46 years in this group with an average follow-up of 30 months. Average duration of surgery was 2 hours. Average hospita l stay was 6 days. Fourteen patients underwent a posterior approach wi th partial lateral laminotomy extending medialy for several millimeter s over the facet joint. Extruded disc material was removed in 10 cases . No curetage was performed. Average age at surgery was 41 years with an average follow-up of 36 months in this group. Average duration of s urgery was 70 minutes. Average hospital stay was 6 days. Results Patie nts were evaluated 3 months post-operatively and at their maximum foll ow-up. At 3 months follow-up, no patient complained of radicular pain; occasional cervical pain was present in 5 cases following posterior s urgery but was not observed at late follow-up. Return to work was poss ible on an average of 3 months in both series. Results were graded as excellent, good, fair and poor. At late follow-up, in patients with a posterior approach, there were 8 excellents results, 5 good results wi th neck fatigue at work, and 1 fair result requiring analgesics. In pa tients with an anterior approach, there were 7 excellent results, 6 go od results, and 1 fair result. Two patients complained of pain at the iliac donor site. Discussion These results suggest that the anterior a pproach gives better short term results, but no significant difference is observed between anterior and posterior approaches a few years aft er surgery. Although the anterior approach is more appropriate than th e posterior one for the treatment of central disc herniation, the post erior approach may be considered as an alternative to anterior discect omy and fusion for antero-lateral soft disc herniation.