[Anterior and antero-lateral surgery for degenerative cervical spine diseases. Role of graft and osteosynthesis. Analysis of practices of the French-speaking european neurosurgeons].

The neurological complications of cervical spondylosis depend on the direct or indirect effects of the mechanical compression of the spinal cord and roots. Nobody questions the interest of a surgical decompression, when the medical treatment is ineffective, but there is no consensus on the choice of the surgical approach and on the necessity of performing a graft with or without osteosynthesis after an anterior decompression. On the initiative of the French Speaking Neurosurgical Society (SNLF), we have analyzed the practices of its European members in 1998 and report here the results of this study which collects 3 645 surgical procedures for degenerative pathology of the lower cervical spine responsible for radiculopathy or myelopathy. An anterolateral approach was used in 85.3 % of all cases, among which 87.9 % of extensive discectomy (Smith Robinson or Cloward technique) and 12.1 % of median somatotomy. In case of discectomy, no grafting was performed in 34.7 % of cases, grafting without fixation in 25.7 %, grafting with plating in 14.9 %, interbody cages in 21.9 %, other techniques in 2.8 %. In case of somatotomy, no grafting was performed in 17.8 % of cases, grafting without fixation in 15.5 %, and grafting with plating in all other cases. When a graft was performed, an autograft was used in 59.5 % of cases, hydroxyapatite in 24.4 %, and many other bone substitutes in rare cases every time. For the fixation, monocortical screwing was used in 75 % of all cases, and bicortical in 25 %. The reasons for these practices are equivocal and not based on scientific attitude. The reasons given are : to avoid discal plucking, to prevent or treat kyphosis and postoperative spinal instability, to prevent cervical postoperative pain, to help eliminate osteophytes and hypertrophy of the ligamentum flavum.