Long-Term Results of Anterior versus Posterior Operations for Herniated Cervical Discs: Analysis of 6,000 Patients

Objective: To analyze the long-term outcomes of anterior versus posterior approaches for cervical disc herniation. Methods: The records of 6,000 patients who had operations for cervical disc herniation (radiating arm pain and/or motor symptoms involving the upper extremity) and who had been followed for at least 2 years (mean: 7.1 years) were culled from the world literature and included in this analysis. The outcome (good/excellent, according to the patient) of anterior versus posterior surgery was compared. Results: Of the 6,000 patients, 2,888 (48.1%) had anterior operations (anterior cervical discectomies, with or without fusion) and 3,112 (51.9%) patients were operated on posteriorly (laminoforaminotomies/'keyhole' facetectomies). Although initially equal, in long-term follow-up, patients who had anterior operations had 80% good/excellent results, whereas patients with the posterior approach had 94% good/excellent results. The difference was significant (p < 0.05). Conclusion: The better long-term results with the posterior operation might be due to the more complete opening of the foramen for neural decompression at the time of the operation and thereafter. (C) 2013 S. Karger AG, Basel