Cervical Spine Anterior Approach, Discectomy, and Corpectomy
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Anterior cervical diskectomy and fusion (ACDF) has been used for almost six decades. First introduced in the 1950s, ACDF is now widely used to treat cervical spondylotic radiculopathy and myelopathy with long-term clinical success. ACDF enables removal of compressive lesions of the spinal cord, such as osteophytes, intervertebral disks, and ossfied posterior longitudinal ligaments (OPLLs). It has also been used to treat a range of other cervical diseases (mainly between C2 and T1 vertebrae) related to cervical instability (degenerative, traumatic, oncological, infectious, inflammatory, iatrogenic). The best predictor of good patient outcomes after surgery is proper preoperative patient selection based on clinical symptoms, physical examination, and imaging studies. ACDF surgery has been shown to have clinical success rates of 97% and 94% for one- and two-level fusions, respectively, at a mean clinical follow-up ≥ 12 months. Overall, complication rates for ACDF operations vary from approximately 5% to 19%. Surgical complications may be categorized as occurring in the preoperative, intraoperative, or postoperative period. Avoiding irreversible complications is the only logical solution to their management. A majority of the complications that occur during an ACDF are avoidable with appropriate patient selection, careful preoperative planning, meticulous surgical technique, and close follow-up and monitoring of the clinical and radiographic conditions of the treated patient. Finally, treatment plans must be individualized based on each patient’s underlying pathology and associated medical condition.