Which surgical procedures are recommended for cervical radiculopathy?
Anterior cervical discectomy (ACD) is indicated when patients have minimal neck pain, normal cervical lordosis, and single-level pathology to avoid the potential complications of fusion. There is a 5% risk of laryngeal nerve injury with ACD.
Anterior cervical discectomy and fusion (ACDF) is indicated for patients with symptoms of instability or more than one operative level. It is limited to levels C3 to C7. It allows for safe removal of osteophytes. Chou R, Atlas SJ, Stanos SP, et al.: Non-surgical interventional therapies for low back pain: A review of the evidence for an American Pain Society clinical practice guideline. Spine 34:1078-1093, 2009. Deyo R, Weinstein J: Low back pain. N Engl J Med 344:363-370, 2001.
ACDF with internal fixation: Plating is recommended for multilevel fusions with documented instability or history of prior fusion failure. It allows early mobilization without bracing.
Posterior cervical discectomy: Usually reserved for either multiple cervical discs or osteophytes, cervical stenosis superimposed on disc herniation, and in situations where the risk of laryngeal nerve injury that is associated with ACD is unacceptable (e.g., professional singers and speakers).
Posterior keyhole laminotomy: Used to decompress only individual nerve roots (not spinal cord). Useful in monoradiculopathy with posterolateral soft disc fragments and in cases in which the anterior approach is either difficult (patients with thick necks) or the risks are unacceptable (professional singers or speakers).