How it is performed

Through a small incision at the front of the neck, usually in a skin crease, the spine is reached by passing between the structures of the neck, without cutting the muscles. Under the microscope, the disc and the osteophytes (bone spurs) compressing the nerves are removed; in place of the disc, an interbody cageis inserted, sometimes secured with a plate or integrated screws, and the two vertebrae fuse onto it. The technique was first described by Smith and Robinson in 1958 [1].

When it is recommended

• Cervicobrachialgia due to a cervical herniation with persistent pain or loss of strength despite conservative treatment.
• Cervical myelopathy, when the spinal cord is compressed at one or a few levels.
• Spondylosis with foraminal stenosis.

Anterior or posterior approach?

In cervical spondylotic myelopathy, a randomised trial found no difference in functional recovery at one year between anterior and posterior surgery: the choice depends on the number of levels, the alignment of the neck and the type of compression [2].

Fusion or disc replacement?

In selected patients with single-level disease, cervical disc replacement is a motion-preserving alternative, with clinical results at least comparable to fusion in randomised trials [3][4]. It is not suitable when there is marked facet joint arthritis or abnormal motion.

After surgery

Patients are usually up on the same day. Mild discomfort when swallowing is normal for a few days. A collar, when needed, is worn for a short period; return to activities is gradual and personalised, with X-ray checks to confirm fusion.