1998 Volume 12 Issue 2 Pages 153-159
Between January 1987 and December 1996, we have performed anterior decompression and interbody fusion with a "Japanese clog" shaped bone graft in 21 patients with cervical myelopathy and/or radiculopathy caused by adjacent multilevel cervical disc disease. There were 17 men and 4 women, the mean age was 51 years, ranging from 25 to 71 years. Their affected levels consisted of C4/5 and C5/6 levels in 11 patients, C5/6 and C6/7 levels in 9 patients, and C4/5, C5/6 and C6/7 levels in one patient. Surgery : After exposure of affected levels as usual fashion, the anterior half of the vertebral body between the two adjacent affected intervertebral discs is drilled out using a high speed drill. The upper part and lower part of the remaining vertebral body also are drilled out for 3mm of their length. The transverse width of the drilled body is about 15 to 18mm. Then discectomy, osteophytectomy and resection of the posterior longitudinal ligament as well as removal of herniated disc materials are carried out at the level of the adjacent affected disc spaces. After sufficient decompression of the neural tissue, a trough is created in the vertebral bodies above and below to allow the bone graft to be wedged in. In Japan no bone bank is available, so a bone graft from the iliac crest is shaped in the form of a Japanese clog, and the cranial end inserted first. The caudal end is gently tamped into place. In all out one of our 21 patients, marked improvement of spondylotic myelopathy was gained. In conclusion, the benefit of this procedure includes a wide working space, sure and safe manipulation of microinstruments, and safe insertion and complete fusion of the bone graft.
