Surgical Planning and Neurological Outcome After Anterior Approach to Remove a Disc Herniation at the C7–T1 Level in 19 Patients

In Brief Study Design. Retrospective cohort study. Objective. The purpose of this study was to report the neurological presentation, outcome and surgical planning in a series of patients with a symptomatic single-level C7–T1 disc herniation who underwent anterior surgical discectomy and fusion. Summary of Background Data. Disc herniations at C7–T1 are uncommon, and there are few large series in the literature describing anterior treatment of such herniations. Methods. We performed a retrospective study of patients who underwent surgery for a C7–T1 disc herniation and reviewed the medical records, operative reports, and imaging studies. The surgeons' view line was drawn and its relation to the manubrium and the great vessels was determined on T1 sagittal magnetic resonance imaging. The location of the herniated disc in the spinal canal was determined using a T2 axial magnetic resonance imaging and classified as central, foraminal, and central/foraminal. Loss of muscle strength was evaluated preoperatively and at the last follow-up according to the classification of the Medical Research Council. The disc space was approached anteriorly by a standard cervical supramanubrial Smith-Robinson approach. Results. We identified 19 patients who had undergone C7–T1 discectomy and fusion. The mean age of the sample was 54.26 ± 8.65 years. There was a higher proportion of male patients (57.9%, 11/19). The clinical presentation was predominantly motor deficit in 15/19 cases (78.9%) in intrinsic hand muscles, and usually improved after surgery. The mean follow-up period was 27.05 ± 15.10 months. All the patients underwent an anterior cervical supramanubrial approach with microdiscectomy and fusion. Anterior cervical plate fixation was used in 9/19 cases (47.3%). In the rest of the cases, a stand-alone intervertebral device was placed. Conclusion. An anterior cervical supramanubrial approach was easily accomplished in all patients. Motor deficit was the most common surgical indication. Level of Evidence: 4 Of the 19 patients with disc herniations at the C7–T1 level, 15 presented with preoperative motor dysfunction. After surgical treatment, only one continued to present motor deficit. Manubriotomy was not necessary in any of the cases. Two of our 10 patients with stand-alone cages required reoperation when the cages extruded.