Cervical Osteochondrosis and Disc Herniation. Eighteen Years' Use of Interbody Fusion by Cloward's Technique in 755 Cases

Seven hundred and forty patients (mean age 51 years) underwent anterior cervical interbody fusion by the method of Cloward in an 18-year period because of cervical osteochondrosis/disc herniation. Fifty-nine needed re-spondylodesis (same or different level or levels in the period. Ninety-six percent presented with radicular symptoms or signs, or both, while seven percent presented with "long tract" symptoms and signs. Myelography was done in all cases except three. Kiel-surgibone was used in 83% of 560 one-level, 177 two-level, and 3 three-level fusions. Eighty-one percent reported total or partial relief of preoperative (predominantly redicular) symptoms and signs postoperatively, but ultimately (observation time 1-13 years) only 71% benefited with regard to neck pain, radicular brachialgia, and neuropathy, and only 42% of those with symptoms and signs of spinal cord compression benefited. Operative complication rate was 4%, and Kiel-surgibone graft problems occurred in 2% of 958 interbody fusions. Beneficial results could be related to short period of symptoms, free intraspinal disc fragments, and a cautious attitude to multi-level fusions. Cloward's interbody fusion is found to be reliable, but delineated attitude to the different types of alternative operations (disc resection, facetectomy or laminectomy) is emphasized.