Over the last 25 years, cervical radiculopathy has been unresponsive to conservative measures such as anti-inflammatory medications, rest, activity modification, physical therapy and pain management injections. Instead, the condition has been treated with a cervical discectomy and fusion, when the etiology is that of a cervical disc herniation. The overall results have been extremely successful. Published literature reports anywhere from a 80 to 95 percent success rate for a one level radiculopathy disc herniation treated by discectomy and fusion. Typically, this has involved a discectomy procedure with complete removal of the disc, followed by replacement of that disc with an allograft, autograft or intravertebral PEEK cage device, which is combined with plates and screws. Despite the overall excellent results, significant issues continue to arise concerning the use of this technology. In particular, it is thought that anywhere from five to 15 percent of patients will have difficulty swallowing secondary to the procedure as well as the plate. Inherently, as the oesophagus involves itself in mechanical motion enabling digestion, the plate which is just behind the trachea and oesophagus could be a source and site of irritation.
With that in mind, over the last three to four years, plateless technology has evolved to allow for cervical discectomy and fusion without the need of plates and screws. One popular system enables an intravertebral cage to be placed within the intravertebral space, followed by self-deploying anchors. This has shown to offer good stability without the need for plates and screws as an adjunct and the results are very promising. This method could potentially enable smaller incisions, since the overall exposure for a plate is larger than that of the device and will have impact on the overall rates of swallowing difficulty.
We have had excellent experiences at the Center for Spinal Disorders, and remain a regional, as well as a national leader in this procedure. Not everyone is a candidate, and certainly there are cases of significant instability, which would include a herniation that necessitates a large amount of the cervical bone to be removed. If this is the case, a plate remains an ideal device. Please contact us or send us your MRIs and x-rays for review and examination.
Wishing you the best of spinal health,
Jonathan Lewin, MD