Clinical evaluation of anterior cervical fusion for degenerative cervical disc disease.

THOUGH the intervertebral disc was described by Vesalius over 400 years ago, its impor tan t role as a cause of various clinical symptoms has been recognized for only 3 decades. In 19s Stookey 17 reported a number of clinical syndromes resulting from protrusion of the cervical discs, but he and other investigators incorrectly identified these protrusions as chondromas, or neoplasms of notochordal origin. During the period from 19~7 to 193~, the investigations of Schmorl and his students in Europe, TM and those of Keyes and Compete in this country TM provided a more precise understanding of the pathophysiology of the intervertebral disc. Finally, the classic paper of Mixter and Barr in 1934,11 clearly correlated protrusion of the lumbar intervertebral disc with symptoms and signs of nerve root compression. Short ly thereafter, damage to the discs of the cervical spine was recognized as an impor tant cause of radicular symptoms in the upper extremities and operative decompression of a cervical nerve root by laminotomy became an established form of therapy for the various syndromes caused by cervical disc protrusion. However, not all neurological surgeons were satisfied with the results of this type of operative t reatment . Consequently, an anterior approach accomplishing total excision of the disc in conjunction with an interbody fusion was independently developed by several workers. 1'14 This approach immediately aroused violent controversy. In this study we review a series of 63 patients who have undergone operation utilizing this anterior approach. We will a t tempt to appraise the results objectively and critically and to determine the proper applica-