{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:47:24Z","timestamp":1792842444157,"version":"4.5.0"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2009,8]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The objective of this systematic review was to use evidence-based medicine to identify the best techniques for anterior cervical nerve root decompression.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to techniques for the surgical management of cervical radiculopathy. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I\u2013III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer-review by the Joint Guidelines Committee of the American Association of Neurological Surgeons\/Congress of Neurological Surgeons.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Both anterior cervical discectomy (ACD) and anterior cervical discectomy with fusion (ACDF) are equivalent treatment strategies for 1-level disease with regard to functional outcome (Class II). Anterior cervical discectomy with fusion may achieve a more rapid reduction of neck and arm pain compared to ACD with a reduced risk of kyphosis, although functional outcomes may be similar. Anterior cervical discectomy with fusion is not a lasting means of increasing foraminal or disc height compared to ACD. Anterior cervical plating (ACDF with instrumentation) improves arm pain (but not other clinical parameters) better than ACDF in the treatment of 2-level disease (Class II). With respect to 1-level disease, plating may reduce the risk of pseudarthrosis and graft problems (Class III) but does not necessarily improve clinical outcome alone (Class II). Cervical arthroplasty is recommended as an alternative to ACDF in selected patients for control of neck and arm pain (Class II).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Anterior cervical discectomy, ACDF, and arthroplasty are effective techniques for addressing surgical cervical radiculopathy.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2009.2.spine08721","type":"journal-article","created":{"date-parts":[[2011,2,23]],"date-time":"2011-02-23T21:42:06Z","timestamp":1298497326000},"page":"183-197","source":"Crossref","is-referenced-by-count":48,"title":["Techniques for anterior cervical decompression for radiculopathy"],"prefix":"10.3171","volume":"11","author":[{"given":"Paul G.","family":"Matz","sequence":"first","affiliation":[{"name":"Division of Neurological Surgery, University of Alabama, Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy C.","family":"Ryken","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Groff","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J.","family":"Vresilovic","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Heary","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Medicine and Dentistry of New Jersey\u2014New Jersey Medical School, Newark, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Langston T.","family":"Holly","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California at San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanvir F.","family":"Choudhri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel K.","family":"Resnick","sequence":"additional","affiliation":[{"name":"Neurological Surgery, University of Wisconsin, Madison, Wisconsin;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0110183","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1007\/s007010050487","article-title":"Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study","volume":"141","author":"Abd-Alrahman","year":"1999"},{"key":"b2-0110183","series-title":"Spine","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1097\/01.BRS.0000058880.89444.A9","article-title":"National and regional rates and variation of cervical discectomy with and without anterior fusion, 1990\u20131999","volume":"28","author":"Angevine","year":"2003"},{"issue":"1","key":"b3-0110183","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients","volume":"12","author":"Barlocher","year":"2002"},{"key":"b4-0110183","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"403","DOI":"10.3171\/spi.2005.2.4.0403","article-title":"Early results after ProDisc-C cervical disc replacement","volume":"2","author":"Bertagnoli","year":"2005"},{"key":"b5-0110183","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/S1529-9430(02)00186-9","article-title":"One- and two-level anterior cervical discectomy and fusion: the effect of plate fixation","volume":"2","author":"Bolesta","year":"2002"},{"key":"b6-0110183","series-title":"J Spinal Disord","first-page":"1","article-title":"Anterior cervical plate stabilization in one- and two-level degenerative disease: overtreatment or benefit?","volume":"11","author":"Caspar","year":"1998"},{"key":"b7-0110183","series-title":"J Spinal Disord","first-page":"202","article-title":"Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates","volume":"9","author":"Connolly","year":"1996"},{"key":"b8-0110183","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"31","DOI":"10.3171\/spi.2006.4.1.31","article-title":"Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site","volume":"4","author":"Coric","year":"2006"},{"key":"b9-0110183","series-title":"J Neurosurg","first-page":"8","article-title":"Anterior cervical discectomy: is fusion necessary?","volume":"90","author":"Dowd","year":"1999"},{"key":"b10-0110183","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2673","DOI":"10.1097\/01.BRS.0000099392.90849.AA","article-title":"Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level","volume":"28","author":"Goffin","year":"2003"},{"key":"b11-0110183","series-title":"Spine","doi-asserted-by":"publisher","first-page":"E371","DOI":"10.1097\/BRS.0b013e318060cca9","article-title":"Short-term comparison of cervical fusion with static and dynamic plating using computerized motion analysis","volume":"32","author":"Goldberg","year":"2007"},{"key":"b12-0110183","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1007\/s005860000210","article-title":"The use of plate fixation in anterior surgery of the degenerative cervical spine: a comparative prospective clinical study","volume":"10","author":"Grob","year":"2001"},{"key":"b13-0110183","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"424","DOI":"10.3171\/spi.2005.3.6.0424","article-title":"Cervical disc arthroplasty: a controlled randomized prospective study with intermediate follow-up results. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2005","volume":"3","author":"Hacker","year":"2005"},{"key":"b14-0110183","series-title":"Cochrane Database Syst Rev","first-page":"CD004958","article-title":"Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease","volume":"4","author":"Jacobs","year":"2004"},{"key":"b15-0110183","series-title":"Neurosurgery","first-page":"229","article-title":"Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft","volume":"50","author":"Kaiser","year":"2002"},{"key":"b16-0110183","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/jns.1980.53.1.0001","article-title":"Anterior surgery for cervical disc disease. Part 1: treatment of lateral cervical disc herniation in 253 cases","volume":"53","author":"Lunsford","year":"1980"},{"key":"b17-0110183","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/S0090-3019(97)00366-2","article-title":"Cost advantages of two-level anterior cervical fusion with rigid internal fixation for radiculopathy and degenerative disease","volume":"48","author":"McLaughlin","year":"1997"},{"key":"b18-0110183","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1016\/j.jocn.2006.04.003","article-title":"Anterior cervical discectomy and fusion: analysis of surgical outcome with and without plating","volume":"14","author":"Mobbs","year":"2007"},{"key":"b19-0110183","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"198","DOI":"10.3171\/spi.2007.6.3.198","article-title":"Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial","volume":"6","author":"Mummaneni","year":"2007"},{"key":"b20-0110183","series-title":"Neurosurgery","first-page":"93","article-title":"Changes in the cervical foraminal area after anterior discectomy with and without a graft","volume":"34","author":"Murphy","year":"1994"},{"key":"b21-0110183","series-title":"Zentralbl Neurochir","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1055\/s-2007-984462","article-title":"Radiographic analysis of fusion progression following one-level cervical fusion with or without plate fixation","volume":"68","author":"Nabhan","year":"2007"},{"key":"b22-0110183","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1097\/BSD.0b013e31802f80c8","article-title":"Anterior cervical microdiscectomy with or without fusion","volume":"20","author":"Oktenoglu","year":"2007"},{"key":"b23-0110183","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1949","DOI":"10.1097\/01.brs.0000176320.82079.ce","article-title":"Kinematic analysis of the cervical spine following implantation of an artificial cervical disc","volume":"30","author":"Pickett","year":"2005"},{"key":"b24-0110183","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"98","DOI":"10.3171\/spi.2006.4.2.98","article-title":"Complications with cervical arthroplasty","volume":"4","author":"Pickett","year":"2006"},{"key":"b25-0110183","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"315S","DOI":"10.1016\/j.spinee.2004.07.024","article-title":"Clinical experience with the new artificial cervical PCM (Cervitech) disc","volume":"4","author":"Pimenta","year":"2004"},{"issue":"3","key":"b26-0110183","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Clinical outcomes with the Prestige II cervical disc: preliminary results from a prospective randomized clinical trial","volume":"17","author":"Porchet","year":"2004"},{"key":"b27-0110183","series-title":"Neurosurgery","first-page":"S112","article-title":"Use of ventral plates for cervical arthrodesis","volume":"60","author":"Resnick","year":"2007"},{"key":"b28-0110183","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"417","DOI":"10.3171\/spi.2005.3.6.0417","article-title":"Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study","volume":"3","author":"Robertson","year":"2005"},{"key":"b29-0110183","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1016\/j.spinee.2004.04.010","article-title":"Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion?","volume":"4","author":"Samartzis","year":"2004"},{"key":"b30-0110183","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"391","DOI":"10.3171\/spi.2007.6.5.391","article-title":"Stress-shielding compared with load-sharing anterior cervical plate fixation: a clinical and radiographic prospective analysis of 50 patients","volume":"6","author":"Saphier","year":"2007"},{"key":"b31-0110183","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1097\/00006123-199807000-00032","article-title":"A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary","volume":"43","author":"Savolainen","year":"1998"},{"key":"b32-0110183","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1007\/s00586-007-0451-6","article-title":"Fusion and failure following anterior cervical plating with dynamic or rigid plates: 6-months results of a multicentric, prospective, randomized, controlled study","volume":"16","author":"Stulik","year":"2007"},{"key":"b33-0110183","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1097\/00006123-199808000-00050","article-title":"The long-term clinical outcome of patients undergoing anterior cervical discectomy with and without intervertebral bone graft placement","volume":"43","author":"Thorell","year":"1998"},{"key":"b34-0110183","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1097\/00024720-200202000-00013","article-title":"Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions","volume":"15","author":"Troyanovich","year":"2002"},{"key":"b35-0110183","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1097\/01.BRS.0000065484.95996.AF","article-title":"Updated method guidelines for systematic reviews in the Cochrane collaboration back review group","volume":"28","author":"van Tulder","year":"2003"},{"key":"b36-0110183","series-title":"J Spinal Disord","first-page":"467","article-title":"The effect of cervical plating on single-level anterior cervical discectomy and fusion","volume":"12","author":"Wang","year":"1999"},{"key":"b37-0110183","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2343","DOI":"10.1097\/00007632-199410150-00016","article-title":"Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up","volume":"19","author":"Watters","year":"1994"},{"key":"b38-0110183","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1080\/02688690500145605","article-title":"To graft or not to graft: rationalizing choice in anterior cervical discectomy","volume":"19","author":"White","year":"2005"},{"key":"b39-0110183","series-title":"Surg Neurol","first-page":"340","article-title":"Cervical discectomy. A prospective analysis of three operative techniques","volume":"53","author":"Wirth","year":"2000"},{"key":"b40-0110183","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1227\/01.neu.0000279730.44016.da","article-title":"Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study","volume":"61","author":"Xie","year":"2007"},{"key":"b41-0110183","series-title":"Acta Orthop Scand","doi-asserted-by":"publisher","first-page":"363","DOI":"10.3109\/17453679808999048","article-title":"One-level cervical spine fusion. A randomized study, with or without plate fixation, using radiostereometry in 27 patients","volume":"69","author":"Zo\u00ebga","year":"1998"},{"key":"b42-0110183","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s005860050224","article-title":"Outcome scores in degenerative cervical disc surgery","volume":"9","author":"Zo\u00ebga","year":"2000"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/11\/2\/article-p183.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/11\/2\/article-p183.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/11\/2\/article-p183.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T21:35:53Z","timestamp":1681594553000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/11\/2\/article-p183.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,8]]},"references-count":42,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2009.2.spine08721","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2009,8]]}}}