Objective: To assess the clinico-radiological outcome of the fusion in anterior cervical decompression and fusion surgeries.

Methods: This was a prospective cross-sectional study. Patients operated through anterior approach for cervical spine disease were included in the study. Patients were operated through anterior approach by employing Smith Robinson’s technique or Cloward technique (on the basis of surgeon’s preference).  Inter body grafts used were iliac crest autograft, artificial G graft from Surgiwear Company. Subjective clinical evaluation was assessed by axial pain and Odom’s criteria. Nurick grade was used to evaluate improvement in neurological myelopathic status.

Results: A total of 62 patients were included in the study. Majority of them were males (80.6%). Majority of them were males (80.6%). Most common age group was 31-40 years. Of the three main group of disease features, degenerative was most common (64.5%). C5/6 disc space was the commonest operated level (64.5%). Iliac crest bone graft was used primarily (46/62=74%) for fusion purpose. Partial anterior graft migration (19.4%) was the most common post-op complication. The subjective assessment of improvement was excellent in 16.1% patients and good was in 45.2%.

Conclusion: Best clinico-radiological improvement was found in degenerative group followed by inflammatory and traumatic.

Keywords: Cervical spine, Fusion, Anterior decompression.

1. Marina Obradov, Menno R. Bénard, Michiel M. A. Janssen, Patricia G. Anderson, Petra J. C. Heesterbeek, Maarten Spruit. Kinematic Magnetic Resonance Imaging Assessment of the Degenerative Cervical Spine: Changes after Anterior Decompression and Cage Fusion. Global Spine J 2016;6:673-678.
2. Lawrence BD, Hilibrand AS, Brodt ED, Dettori JR, Brodke DS. Predicting the risk of adjacent segment pathology in the cervical spine: a systematic review. Spine (Phila Pa 1976) 2012;37(22, Suppl):S52-S64.
3. Fielding JW. Normal and selected abnormal motion of the cervical spine from the second cervical vertebra to the seventh cervical vertebra based on cineroentgenography. J Bone Joint Surg Am 1964;46(8):1779-1781.
4. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH.Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999;81(4):519-528.
5. Eck JC, Humphreys SC, Lim T-H, et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976) 2002;27(22): 2431-2434.
6. Girard V., Leroux B. , Brun V. ,  Bressy G., Sesmat H. , Madi K. Post-traumatic lower cervical spine instability: Arthrodesis clinical and radiological outcomes at 5years. Orthopaedics & Traumatology: Surgery & Research 2014.
7. Hannallah D., Andrew A.P., Fassett D., Kerr S., Whang P.G., Hilibrand A.S. Adjacent level degeneration in the cervical spine Oper Tech Orhtop 2007 ;  17 : 178-182
8. Goffin J., van Loon J., Van Calenbergh F., Plets C. Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine J Spinal Disord 1995 ;  8 : 500-508.
9. Lawrence BD, Hilibrand AS, Brodt ED, Dettori JR, Brodke DS. Predicting the risk of adjacent segment pathology in the cervical spine: a systematic review. Spine (Phila Pa 1976) 2012;37 (22, Suppl):S52–S64.
10. Kolstad F, Nygaard ØP, Leivseth G. Segmental motion adjacent to anterior cervical arthrodesis: a prospective study. Spine (Phila Pa 1976) 2007;32(5):512–517.
11. Kelly MP,Mok JM, Frisch RF, Tay BK. Adjacent segment motion after anterior cervical discectomy and fusion versus Prodisc-c cervical total disk arthroplasty: analysis from a randomized, controlled trial. Spine (Phila Pa 1976) 2011;36(15):1171–1179.
12. Reddy A. Mastan, Faisal Gulam Mustafa, Jyothi Sangam M. A study of indications and assessment of fusion rates for atlantoaxial subluxation. Int Surg J. 2016; 1: 1211-216.
13. Haid RW, Subach BR, McLaughlin MR, Rodts GE, Wahlig JB. C1-C2 transarticular screw fixation for atlantoaxial instability: a 6 years’ experience neurosurgery.2001; 4 9(1): 69-70.
14. Komura S, Miyamoto K, Hosoe H, et al. Lower incidence of adjacent segment degeneration after anterior cervical fusion found with those fusing C5-6 and C6-7 than those leaving C5-6 or C6-7 as an adjacent level. J Spinal Disord Tech 2012; 25:23–29.
15. Sakaura H., Hosono N., Mukai Y., Ishii T., Iwasaki M., and Yoshikawa H. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion. Spine, vol. 30, no. 7, pp. 756–759, 2005.
16. Martin GJ, Haid RW Jr, MacMillan M, Rodts GE Jr, Berkman R. Anterior cervical discectomy with freeze-dried fibula allograft: Overview of 317 cases and literature review. Spine 1999; 24: 852-859.
17. Brower RS, Herkowitz HN, Kurz L. Effect of distraction on the union rate of Smith-Robinson type anterior cervical discectomy and fusion. Presented at the Cervical Spine Research Society 1992; Palm Springs, CA.

Dr DK Vatsal M.S., M.Ch.

Assistant Professor of Neurosurgery, Department of Surgery, Hind Institute of Medical Sciences, Safedabad, Barabanki, India