Let’s say you have neck pain. Or maybe you develop pain running down your arm. You see your doctor and he or she determines the cause is from a degenerated disc in your neck (spondylosis) or possibly a herniated disc. After a few failed conservative treatments he’ll probably tell you that you need a cervical discectomy with or without a fusion. What does that mean? Typically, cervical discectomies are done from the front or the side, known as an anterior cervical discectomy (ACD). The disc is removed and often the vertebrae above and below the removed disc are fused together, but not always. So which is better – anterior cervical discectomy with a fusion (ACDF) or without a fusion? We recently ran across a study that showed neither is superior.1 And further, neither shows long-term favorable results, leading us to believe that Prolotherapy is the superior treatment to a cervical discectomy and fusion.
An anterior cervical discectomy involves disc removal through the front or side of the neck.
The study took place in the Netherlands where researchers reviewed 551 patient charts. Each patient had an ACD between the year 1985 and 2000. They also interviewed 102 patients to determine long-term outcomes. They compared their results to studies that had already been published on ACDF. They found that two months after ACD surgery 90% of patients had desirable outcomes. As time went on, however, complaints of neck pain and pain radiation down the arm (cervical radiculopathy) increased and only 67% of the patients were satisfied with the surgery at the time of the survey. 20% had moderate complaints of pain affecting daily life, and 12% had severe complaints of their pain affecting everyday life. The study concluded that compared to ACDF, ACD was comparable with short-term satisfaction and increased complaints long-term.
Back to your hypothetical situation (or, we hope not, but real life situation), what do you do with your neck pain when your doctor recommends an ACD or ACDF knowing there’s a large chance you’re not going to have long-term satisfaction? The answer is Prolotherapy! The problem with ACD is that it is not addressing the root cause of your pain – degenerated ligaments of your cervical spine. Removing a disc only further destabilizes the spine, leading to more degeneration over the years. A fusion puts stress on the vertebrae above and below the fused segment leading to degeneration in more than one vertebrae. The logical solution is the strengthen the structures around the disc to take pressure off the disc and alleviate pain. Ligament laxity is the root cause of the pain and must be addressed.
1. Rishi D. S. Nandoe Tewarie, Ronald H. M. A. Bartels, Wilco C. Peul. Long-term outcome after anterior cerivcal discectomy without fusion. Eur Spine J. 2007 September; 16(9): 1411–1416.