EURASIAN JOURNAL OF MEDICAL AND
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Innovative Academy Research Support Center
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Volume 5 Issue 7, July 2025 ISSN 2181-287X
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ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT
OF HERNIATED DISCS OF THE CERVICAL SPINE USING
ANTERIOR DECOMPRESSION AND INTERBODY CAGE
Parvoz Abdulhakimov
Samarkand state medical university, Samarkand, Uzbekistan
https://doi.org/10.5281/zenodo.15914746
ARTICLE INFO
ABSTRACT
Received: 08
th
July 2025
Accepted: 14
th
July 2025
Online: 15
th
July 2025
,
The aim of the study
was to study the results of surgical
treatment of the cervical spine with anterior decompression and
interdiv cage stabilization.
Material and methods.
An analysis of the immediate and
remote (from 12 months to 5 years) results of surgical treatment
using the anterior intercorporeal method was performed. spinal
fusion (anterior cervical discectomy and fusion - ACDF) 57
patients with diseases of the cervical spine.
Results
The treatment outcome was assessed based on clinical
examination data in accordance with the Odom criteria, and the
neurological status was assessed in accordance with the criteria
proposed by the Japan Orthopedic Association (JOA).
Conclusions.
A study of the long-term results of surgical
treatment of patients with degenerative-dystrophic diseases of
the cervical spine using the ACDF technique showed high
efficiency, reliability and safety of anterior decompression and
stabilization with titanium cages.
KEYWORDS
Cervical spine, anterior
decompression, interdiv
stabilization, cage.
Osteochondrosis of the cervical spine ranks second after the lumbar spine and is often
found among able-bodied patients aged 25–60 years. The danger of osteochondrosis of the
cervical spine is associated with a high risk of developing myelopathies with severe
neurological disorders, which leads to a deterioration in the quality of life and high disability
[5]. Today, there are many methods of surgical treatment of herniated discs of the cervical
spine, including anterior cervical discectomy with interdiv spinal fusion (anterior cervical
discectomy and fusion — ACDF) is the "gold standard" for treating patients with cervical
osteochondrosis. The ACDF technique was first described in 1955 by Robinson and Smith [2, 4,
10], then in 1956 Coward [9] modified it. According to vertebrologist surgeons, the ACDF
technique is technically simple and its correct use is not accompanied by the development of
postoperative complications. At the same time, with the introduction of new implants in
vertebral surgery and the development of an evidence base, an active search is underway for
the optimal technique and the best implant for the treatment of cervical osteochondrosis.
Over the past ten years, in vertebral surgery for interdiv spondylodesis, so-called cage
structures made of metal alloys have found wide application [2, 3, 8]. Obtaining primary
reliable, optimal stabilization of the operated spinal -motor segment, allowing the patient to be
activated in the shortest possible time without cumbersome external immobilization, is the
main goal of stabilizing surgical treatment of the spine. The problem of reliable fixation is most
EURASIAN JOURNAL OF MEDICAL AND
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Volume 5 Issue 7, July 2025 ISSN 2181-287X
Page 24
closely related to the choice of surgical access and material for the interdiv spondylodesis [1,
6]. Cage structures meet these requirements. Over the past ten years, vertebral surgery for
interdiv spondylodesis, so-called cage structures made of metal alloys have found wide
application [7]. The use of cages has dramatically increased the effectiveness of the ACDF
interdiv technique spondylodesis. Thus, the effectiveness of spondylodesis increased from
56% when using bone implants to 93% when using cages [4].
According to a number of authors, decompressive and stabilizing operations on the
cervical spine should pursue the following goals:
1) adequate and safe decompression of intracanal vascular-nerve formations;
2) stabilization of the affected vertebral segment in a functionally advantageous position
[6];
3) installation of an interdiv implant to restore the height of the interdiv space [1, 3,
4].
In order to improve the methods of interdiv stabilization of the cervical spine, we have
developed an original titanium cage, for which we have received a patent from the PV RUz (No.
FAP 00297 dated 06/25/2007).
The aim of the study
was to investigate the results of surgical treatment of the cervical
spine with anterior decompression and interdiv cage stabilization of our own design.
Material and methods
The object of the study were 57 patients with degenerative instability of the cervical spine,
treated in the vertebrology department of the Research Institute of Traumatology and
Orthopedics of the Ministry of Health of the Republic of Uzbekistan in the period from 2012 to
2018. Of these, 41 were men and 16 were women. The average age of patients was 39 years.
Most patients were of working age - from 30 to 55 years.
The
distribution of patients by anatomical levels of the pathological process is as follows:
at the level of C3
–
C4
—
5 patients (11%), C4
–
C5 — 6 patients (10.7%), C5
– C6
— 26 patients
(45.6%), C6
– C7
— 20 patients (35.%). Discogenic compression at one level was detected in 49
patients, at two levels — in 8. Myelopathy was detected in 33 patients and radiculopathy — in
14.
All patients underwent clinical examination (including neurological status), radiological
and tomographic (CT, MRI, MSCT) methods and electroneuromyographic studies (Neurosoft -
MVP Russia).
In order to decompress the spinal cord and nerve elements, all patients underwent
surgical intervention in the amount of anterior interdiv decompression of the spinal canal
with a crown burr and interdiv stabilization with a titanium cage of the cervical spine.
Results
Remote treatment results for periods from 1 year to 5 years were studied in 57 patients
after surgical treatment. The results of surgical treatment of cervical spine stenosis were
assessed in accordance with the Odom criteria, VAS and the Japanese Orthopedic Association
(for the leading syndrome of cervical myelopathy, the Japanese scale was used). Orthopedic
Association (JOA).
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They were assessed from the initial state according to the neurological status, the state of
the musculoskeletal functions of the cervical spine, the position of the anatomical and
biomechanical axis of the operated spinal motor segment.
In X-ray examination at a later date, all patients showed signs of interdiv space
formation. spondylodesis.
According to the Odom criteria, an excellent result is considered to be the absence of all
preoperative symptoms and pathological signs, which were observed in 18 (38%) patients in a
separate period after surgery.
A good result was considered to be minimal preservation of preoperative symptoms,
improvement or preservation of pathological signs. A good result was obtained in 21 (44%)
patients.
A satisfactory result was found in 7 (15%) patients, which was characterized by a certain
improvement in preoperative symptoms, other pathological signs did not change or improved
slightly.
An unsatisfactory result was obtained in 1 (4%) patient, in whom the symptoms and
pathological signs of cervical spine stenosis did not change.
As a clinical example, we present the following observation. Patient R., 54 years old,
diagnosis: herniated disc C5–C6. She has been ill for several years, has repeatedly received
conservative treatment. Objectively, the cervical lordosis is smoothed, the paravertebral
muscles are tense, active movements in the cervical spine are limited, pain on palpation at the
level of C5
–
C6
,
the pain spreads to the left upper limb. Also noted is decreased sensitivity in
the innervation zone of C6
and
muscle hypotrophy. Tendon reflexes are reduced (Fig. 1).
Figure 1. Spondylogram of the cervical spine before surgery: a - direct projection; b
- lateral projection
Figure 1. Spondylogram of cervical spine before the operation: a — frontal
projection; b - lateral projection
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MRI and X-ray show signs of cervical osteochondrosis. Cervical lordosis is smoothed.
Narrowing of the intervertebral space C5
-
C6
.
Herniated intervertebral disc C5
-
C6
.
Spinal canal
stenosis at the level of C5
-
C6
(
Fig. 4).
Figure 2. MRI tomograms of the cervical spine Figure 2. MO tomograms of cervical
spine
discectomy operation of C5
-
C6 was performed, with stabilization of the spinal motor
segment with a titanium cage . In the postoperative period,
the
wound heals by primary
intention. External immobilization of the neck with a rigid corset for a period of 1 month.
After 3 months, there are no complaints. Formation of a bone-metal block at the level of
C5–C6 is noted
.
Complete regression
of neurological symptoms, the spinal axis is normal (Fig.
3).
Figure 3. Spondylogram of the cervical spine after surgery. Segments C5 – C6 are
fixed with a titanium cage of our own design by anterior interdiv spondylodesis: a -
direct projection; b - lateral projection
Conclusions
EURASIAN JOURNAL OF MEDICAL AND
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Volume 5 Issue 7, July 2025 ISSN 2181-287X
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The study of remote results of surgical treatment of patients with degenerative-
dystrophic disease of the cervical spine by the ACDF method showed high efficiency, reliability
and safety of anterior decompression and stabilization with titanium cages. As a result of the
operation, decompression of the neurovascular structures of the spinal canal was eliminated,
stable fixation was achieved, positive dynamics in neurological symptoms were noted. The
technique of anterior spondylodesis of the cervical spine is simple and effective and with
minimal complications if performed correctly.
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