During the period 1958 to 1962, 102 patients with disabling and painful conditions involving the upper extremities and neck were subjected to diagnostic examination by clinical and roentgenographic methods. Practically all patients had received various forms of conservative treatment. The distribution of pain varied but paresthesias and numbness were almost always localized to the fingers. In the majority of patients it proved impossible to find evidence of neurological impairment; electromyograms were rarely helpful. Eighty per cent of patients were between forty and sixty years of age. The ratio of men to women was 3 to 1.
Plain roentgenograms of the cervical spine showed degeneration of one or more discs in practically all patients, but since such changes are common in this age group this finding was of limited diagnostic value. Examination of the mobility in the cervical spine in some patients by cineroentgenography gave inconclusive results and could not be relied upon as a basis for diagnosis of the level of involvement. Cervical phlebography was in our experience an erratic technique. Discography permitted visualization of the pattern of rupture in a degenerated disc and produced pain which could rarely be evaluated. Myelography provided the most reliable preoperative information.
Forty-five patients who were operated on during the years 1958 to 1962 were re-examined one to four years later. The operation consisted in anterolateral exploration of the cervical discs and partial resection of disc tissue at one or several levels. No form of osteosynthesis was carried out in any patient. In half of the patients, the operation produced immediate relief from pain and regression of the symptoms, including tension states. Thirty-five patients with positive myelograms were followed one to four years postoperatively; twenty-nine (83 per cent) had returned to wage-earning occupations and were either completely recovered or considerably improved. Because of distressing symptoms, eight patients were operated on despite a negative myelogram. The discs resected were selected on the basis of the degree of disc degeneration on plain roentgenograms. In only one of these cases did the operation produce lasting benefit.
Partial disc resection may lead to bone fusion between the vertebrae above and below the excised disc or to fibrous union. This occurred even in patients with poor results. In these unsuccessful cases, we may not have operated on the correct level or the patients may not have had disc disease. We do not consider intervertebral osteosynthesis a necessary complement to disc resection.
Since excision of cervical discs must be guided by diagnostic methods which indicate the level or levels of nerve-root involvement, for the time being, myelography seems to provide the most reliable preoperative information.
Copyright 1964 by The Journal of Bone and Joint Surgery, Incorporated