Cloward, J Neurosurg 1958 - The Anterior Approach for Removal of Ruptured Cervical Disks

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The Anterior Approach for Removal of Ruptured Cervical Disks

Cloward·J Neurosurg·1958·1,796 citations·Case series

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Cloward tested whether an anterior approach to the cervical spine could remove ruptured discs, decompress nerve roots and cord, and achieve interbody fusion. Case series of 47 consecutive patients with ruptured cervical discs after failed conservative care, treated by anterior discectomy and dowel bone-graft fusion with custom instruments, assessing pain, neurology and fusion.

Key Findings

Pain relief: complete in 89% (42/47), improved in the remaining 5, with no failures.
Interbody fusion occurred in 94% (44/47) by 3 to 4 months. Radiographic union appeared as early as 6 to 8 weeks.
Neurological outcome in 29 patients with preoperative deficits:
- Complete recovery: 69% (20/29)
- Marked improvement: 6 patients
- Worsened: 1 patient
C5-6 was the most common level (59%, 28/47). Six patients had two-level fusions. Most patients (40/47) stayed a mean 4.5 days and walked within 24 hours.
Significance: Described anterior cervical discectomy with dowel interbody fusion, now known as the Cloward technique, showing that ruptured cervical discs could be removed from the front with reliable pain relief and fusion.

Board PearlCloward's anterior cervical discectomy and dowel fusion achieved 94% fusion and 89% complete pain relief, and the one serious complication, a posterior longitudinal ligament breach with intraspinal hemorrhage, ended in an excellent recovery.

The Anterior Approach for Removal of Ruptured Cervical Disks.

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The Anterior Approach for Removal of Ruptured Cervical Disks

Cloward·J Neurosurg·1958·1,796 citations·Case series

|

Cloward tested whether an anterior approach to the cervical spine could remove ruptured discs, decompress nerve roots and cord, and achieve interbody fusion. Case series of 47 consecutive patients with ruptured cervical discs after failed conservative care, treated by anterior discectomy and dowel bone-graft fusion with custom instruments, assessing pain, neurology and fusion.

Key Findings

Pain relief: complete in 89% (42/47), improved in the remaining 5, with no failures.
Interbody fusion occurred in 94% (44/47) by 3 to 4 months. Radiographic union appeared as early as 6 to 8 weeks.
Neurological outcome in 29 patients with preoperative deficits:
- Complete recovery: 69% (20/29)
- Marked improvement: 6 patients
- Worsened: 1 patient
C5-6 was the most common level (59%, 28/47). Six patients had two-level fusions. Most patients (40/47) stayed a mean 4.5 days and walked within 24 hours.
Significance: Described anterior cervical discectomy with dowel interbody fusion, now known as the Cloward technique, showing that ruptured cervical discs could be removed from the front with reliable pain relief and fusion.

Board PearlCloward's anterior cervical discectomy and dowel fusion achieved 94% fusion and 89% complete pain relief, and the one serious complication, a posterior longitudinal ligament breach with intraspinal hemorrhage, ended in an excellent recovery.

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