Abstract
INTRODUCTION: Giant cervical disc herniation (GCDH), defined as CDH occupying more than 50% of the spinal canal, presents a significant challenge in spinal surgery. This study specifically investigated a distinct subgroup of patients with soft GCDH, characterized by an absence of ossification of the posterior longitudinal ligament (OPLL) or significant calcification. AIM: We aimed to assess the feasibility and efficacy of microscopy-assisted anterior cervical discectomy and fusion (MS-ACDF) for treating soft GCDH-induced cervical spondylotic myelopathy (GCDH-CSM). MATERIALS AND METHODS: This retrospective study analyzed 22 consecutive patients with soft GCDH-CSM who underwent MS-ACDF. The inclusion criteria explicitly required confirmation of soft DH without OPLL or signs of significant calcification on preoperative imaging. The analysis included clinical and imaging data, encompassing demographic characteristics, pre- and postoperative visual analog scale (VAS), Neck Disability Index (NDI), and Japanese Orthopedic Association (JOA) scores, X-ray, magnetic resonance imaging (MRI), and computed tomography results to assess efficacy of the technique. RESULTS: All surgical procedures were successfully completed without complications, demonstrating the safety and reliability of the MS-ACDF technique. Postoperative assessment showed marked clinical improvement, with MRI confirming thorough removal of the herniated disc and adequate decompression of the spinal cord. During a median (interquartile range [IQR]) follow-up of 14 (13-17) months, mean (SD) VAS and NDI scores, respectively, decreased from preoperative 4.82 (1.11) and 15.95 (2.26) to 2.22 (1.08) and 10.22 (2.02) at day 3 postoperatively, and further to 0.77 (0.79) and 7.04 (1.06) at the final follow-up. Mean (SD) JOA score improved from 9.27 (1.81) preoperatively to 12.77 (1.51) on postoperative day 3, and further increased to 15.22 (0.95) at the final follow-up. No severe complications were noted. CONCLUSIONS: MS-ACDF represents a viable option for soft, noncalcified GCDH, providing satisfactory clinical and functional improvement at mid-term follow-up.