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.