Extended anterior cervical decompression without fusion: a long-term follow-up study

We report the long-term outcome in 80 patients who had undergone extended anterior cervical decompression without fusion for cervical nerve root or spinal cord compression. Follow-up ranged from 2 years 4 months to 13 years. Five patients had died from causes unrelated to the original pathology or the surgery. Of the remaining 75 patients, 66 (88%) were symptom free or clearly improved, eight (10%) were unchanged and one patient (1.5%) was worse. Sixty-eight patients (91%) were satisfied with the outcome of treatment. Nineteen patients (25%) had some degree of residual neck pain, but in none was this a major problem. Three patients had required subsequent surgery for cervical disc protrusions at levels adjacent to the first operation, while two patients had developed foraminal stenosis at the level of the surgery and had undergone foraminotomy. One patient had developed a symptomatic flexion deformity. Radiological assessment revealed bony fusion in 71%, some degree of flexion deformity in 13% and some degree of foraminal stenosis in 38%. Our results suggest that the initial good results of extended anterior cervical decompression without fusion are maintained long-term. Although a small number of patients eventually develop problems that might be avoided by an initial spacing procedure/formal fusion, these are no greater than the immediate problems associated with the harvesting and insertion of a bone graft.