Microsurgery of the cervical spine: The anterior approach

Abstract

Numerous valuable reviews on anterior cervical discectomy, interbody fusion, vertebrectomy, and anterior plating are available. Since 1990 approximately 210 papers dealing with these topics have been published. Nevertheless, clear-cut answers to some questions are still lacking: Which traumatic lesions of the C-spine would be treated better by an anterior than by a posterior approach? Is plain discectomy a sufficient treatment of singlelevel degenerative disc disease? In which cases should disc prosthesis be preferred to interbody fusion? Should autologous bone graft be used routinely in anterior cervical fusion? Does corpectomy offer advantages over multiple interbody fusion in the case of multilevel spondylotic cervical myelopathy? Can internal fixation be recommended in the surgical treatment of cervical spondylodiscitis? Is the use of a bone strut indicated for reconstruction of the C-spine in tumor disease? When does the indication for anterior plating become controversial? Unfortunately, this paper cannot offer enough evidence to proclaim a specific procedure the "gold standard." The author had the privilege to work 11 years with Wolfhard Caspar and after 22 years still enjoys his clinical cooperation. The maxim "good judgement comes from experience and experience comes from bad judgement" has been substantiated by quite a large personal series of anterior cervical procedures. The following pages should be understood as a subjective frame of recommendations. The final decision on the surgical approach should be well founded on the patient's clinical pattern, the surgeon's experience, and cost consciousness. © Springer-Verlag Berlin Heidelberg 2006.