Outcomes of microscopy‑assisted anterior cervical discectomy and fusion in a selected cohort with soft giant cervical disc herniation‑induced cervical spondylotic myelopathy.

INTRODUCTION

Giant cervical disc herniation (GCDH), defined as CDH occupying more than 50% of the spinal canal, presents a significant challenge in spinal surgery. This study specifically investigated a distinct subgroup of patients with soft GCDH, characterized by an absence of ossification of the posterior longitudinal ligament (OPLL) or significant calcification.

AIM: We aimed to assess the feasibility and efficacy of microscopy-assisted anterior cervical discectomy and fusion (MS-ACDF) for treating soft GCDH-induced cervical spondylotic myelopathy (GCDH-CSM).

MATERIALS AND

METHODS

This retrospective study analyzed 22 consecutive patients with soft GCDH-CSM who underwent MS-ACDF. The inclusion criteria explicitly required confirmation of soft DH without OPLL or signs of significant calcification on preoperative imaging. The analysis included clinical and imaging data, encompassing demographic characteristics, pre- and postoperative visual analog scale (VAS), Neck Disability Index (NDI), and Japanese Orthopedic Association (JOA) scores, X-ray, magnetic resonance imaging (MRI), and computed tomography results to assess efficacy of the technique.

RESULTS

All surgical procedures were successfully completed without complications, demonstrating the safety and reliability of the MS-ACDF technique. Postoperative assessment showed marked clinical improvement, with MRI confirming thorough removal of the herniated disc and adequate decompression of the spinal cord. During a median (interquartile range [IQR]) follow-up of 14 (13-17) months, mean (SD) VAS and NDI scores, respectively, decreased from preoperative 4.82 (1.11) and 15.95 (2.26) to 2.22 (1.08) and 10.22 (2.02) at day 3 postoperatively, and further to 0.77 (0.79) and 7.04 (1.06) at the final follow-up. Mean (SD) JOA score improved from 9.27 (1.81) preoperatively to 12.77 (1.51) on postoperative day 3, and further increased to 15.22 (0.95) at the final follow-up. No severe complications were noted.

CONCLUSIONS

MS-ACDF represents a viable option for soft, noncalcified GCDH, providing satisfactory clinical and functional improvement at mid-term follow-up.