Minimally invasive methods in anterior approach for cervical discogenic disease

Abstract

Cervical discogenic disease is common and often associated with ossification of the posterior longitudinal ligament (OPLL), causing myelopathy and radiculopathy. Surgical treatment has changed with time. But it is generally done by a neurosurgeon using an anterior approach with various methods. In this paper we discuss a new a minimally invasive approach. Additionally surgical indication, advantages and disadvantages of each method are discussed. In the keyhole anterior approach without bone graft, medial discectomy is indicated for central or paramedian discs, while transuncal foraminotomy is quite effective for far-lateral or foraminal discs or spurs. Keyhole oblique discectomy is also useful for relatively small central disc to avoid anterior angulation. Williams' method with vertebral graft can be effective for cervical spondylosis with OPLL, but fragile grafts way need to be reinforced by ceramic sandwich or anterior plating. The recent method of interbody cage fixation using vertebral graft and ceramics is very effective and shows promise for segmental OPLL and cervical spondylosis with instability or bilateral prominent spur, patients are ambulatiory, dischanged from the hospital and back to working quicker than other methods. However, long term follow-ups for alignment of the cervical spine are necessary.