Evaluation of Different Modalities of anterior Cervical Discectomy for Treatment of Single and Double Level Cervical Disc Herniation

Cervical disc herniation and degenerative disease of the cervical spine are the most common causes of cervical cord and nerve root dysfunction. It is found that after the age of 40 almost 60% of the population will have radiographic evidence of degenerative changes, and after the age of 65, 95% of men and 70% of women have radiographic evidence of degenerative changes [1]. Since the first description of the anterior cervical discectomy with fusion by Cloward and Smith in 1958 respectively in 1955, and the cervical anterior discectomy without fusion in 1960 by Hirsch a debate is started which of both methods is the best. While this discussion is still not closed, the advent of the cervical disc prosthesis has contributed to extra confusion. Instead of two possibilities, nowadays three possible treatments concur with each other: anterior cervical discectomy without implantation of any structure, anterior cervical discectomy with fusion, and finally, cervical discectomy with implantation of disc prosthesis [2]. Nowadays anterior cervical discectomy and fusion (ACDF) may be considered the standard procedure for treatment of degenerative disc disease of the cervical spine. However, there is evidence that ACDF may result in progressive degeneration of the adjacent segments [3].