311 Smith-Robinson Procedure With an Autologous Iliac Crest Bone Graft With and Without Caspar Plating as a Treatment for Soft Cervical Disc Herniation: Report of 122 Patients With an Average Follow-up of 25 Years.

INTRODUCTION: The purpose was to evaluate the long-term clinical outcome for the surgical treatment of cervical disc herniation. Special focus was given to assess pain, functional outcome, and symptomatic adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF) and ACDF with Caspar plating (ACDF+PS).

METHODS: Hospital records of 226 patients who were affected by soft cervical disc herniation and treated by ACDF or ACDF+PS were reviewed. Information about diagnosis, procedure, pre- and postoperative clinical process, and complications were analyzed. Patients were reviewed with a standardized questionnaire including the current neurological status, Neck Disability Index (NDI), EQ-5D, Patient Satisfaction Index, Odom criteria, and limitations in quality of life. Special interest was pointed out to symptomatic adjacent segment disease and reoperation.

RESULTS: One-hundred twenty-two patients with a mean follow-up of 25 years were evaluated. Eight had ACDF and 42 had ACDF+PS. Seventy-eight patients had single-level surgery, 40 had 2-level surgery, and 4 patients had 3-level surgery. In 89.3% patients with preoperative pain reported to be free of pain at follow-up. The mean NDI is 14%, mean EQ-5D-score was 5, according to Odom criteria 86.1% of patients had a good to excellent functional recovery, according to the PSI 98.4% of patients were satisfied or very satisfied. There was no significant difference between patients who were operated via ACDF and patients operated via ACDF+PS concerning EQ-5D, NDI, Odom, PSI, rate of patients without pain, and rate of reoperation due to degenerative changes. Thirteen patients underwent a second surgery because of degenerative changes among those 9 due to symptomatic ASD.

CONCLUSION: The overall prevalence for symptomatic ASD was 8.4% after more than 25 years. ACDF and ACDF+PS yields significant decrease in pain, increase in function even after more than 20 years. There are no statistical differences concerning pain reduction, functional outcome, and rate of reoperation due to degenerative changes.