Ventral discectomy with PMMA interbody fusion for cervical disc disease - Long-term results in 249 patients

Study Design. Retrospective study of patients who underwent ventral discectomy and polymethyl-methacrylate (PMMA) interbody fusion for cervical radiculopathy. Objectives. To evaluate the long-term outcome after ventral discectomy and PMMA interbody fusion and to compare it with previous data from other surgical techniques for the treatment of cervical radiculopathy. Summary of Background Data. Because PMMA interbody fusion after ventral discectomy does not result in solid bony fusion in all cases, a good long-term outcome using this surgical technique has been questioned. Methods. Long-term follow-up evaluation after surgery was performed in 249 patients (96 women and 153 men) with radicular signs only. The mean age was 46.0 +/- 8.7 years (range, 24-74 years), and the observation time ranged from 10-15 years (mean, 12.2 +/- 1.2 years). Clinical grading after surgery according to Odom's criteria was based on a questionnaire. The outcome was related to morphologic findings, lumbar symptoms, physical stress, duration of symptoms, age, sex, and cervical level involved. Results. Complications related to surgery occurred in 13 (5.2%) patients, but only three (1.2%) had persistent problems. Of the 249 patients, 101 (40.6%) were without any symptoms (Odom I), 92 (36.9%) had a good outcome (Odom II), and 47 (18.9%) a fair outcome (Odom III). Only nine patients (3.6%) reported an unchanged or worse status than before surgery (Odom IV). Additional lumbar symptoms, high occupational physical stress, and discrepancy of preoperative findings were significantly correlated with a worse outcome. Short duration of symptoms and soft disc disease were favorable prognostic factors. Conclusions. PMMA interbody fusion after ventral discectomy in cervical disc surgery is a safe and reliable method with few complications and an outcome! comparable with other ventral procedures.