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The Journal of Bone and Joint Surgery, Vol 75, Issue 9 1298-1307, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients
HH Bohlman, SE Emery, DB Goodfellow and PK Jones
Reconstructive and Traumatic Spine Surgery Center, University Hospitals of Cleveland.
We evaluated the results of the Robinson method of anterior cervical
discectomy and arthrodesis with use of autogenous iliac-crest bone graft,
at one to four levels, in 122 patients who had cervical radiculopathy. A
one-level procedure was done in sixty-two of the 122 patients; a two-level
procedure, in forty-eight; a three-level procedure, in eleven; and a
four-level procedure, in one. The average duration of clinical and
roentgenographic follow-up was six years (range, two to fifteen years). The
average age was fifty years (range, twenty-five to seventy-eight years).
Preoperatively, 118 patients had pain in the arm, fifty-five had weakness
of one or more motor roots, and seventy-seven had sensory loss. At the time
of follow-up, eighty-one patients had no pain in the neck, twenty-six had
mild pain in the neck, nine had moderate pain in the neck, four had mild
radicular pain, and two had a combination of mild radicular pain and
moderate pain in the neck. One hundred and eight patients had no functional
impairment, and fourteen had a slight limitation of function during the
activities of daily living. Nine of eleven patients who had symptoms
related to a change at one level cephalad or caudad to the site of a
previous arthrodesis had another operative procedure. Lateral
roentgenograms of the cervical spine, made in flexion and extension, showed
a pseudarthrosis at twenty-four of 195 operatively treated segments.
Sixteen of the patients who had a pseudarthrosis were symptomatic, but only
four had sufficient pain to warrant revision. The risk of pseudarthrosis
was significantly greater after a multiple-level arthrodesis than after a
single-level arthrodesis (p < 0.01). At the time of the most recent
follow-up, fifty-three of the fifty-five patients who had had a motor
deficit had had a complete recovery, and the two remaining patients had had
a partial recovery. Seventy-one of the seventy-seven patients who had had a
sensory loss had regained sensation. None of the patients had an increased
neurological deficit postoperatively. Our results suggest that the Robinson
anterior cervical discectomy and arthrodesis with an autogenous iliac-crest
bone graft for cervical radiculopathy is a safe procedure that can relieve
pain and lead to resolution of neurological deficits in a high percentage
of patients.
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