الفهرس 
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Abstract
Cervical spondylosis is a term that encompasses a range of progressive degenerative changes that affect all the components of the cervical spine.
Its symptoms include neck pain and stiffness and can be accompanied by more serious manifestations as radicular symptoms when there is compression of neural structures. Most people with spondylotic changes of the cervical spine on radiographic imaging remain asymptomatic, with 25% of individuals under the age of 40, 50% of individuals over the age of 40. The most frequently affected levels are C6-C7, followed by C5-C6.
The prevalence of cervical disc herniation increases with age for both men and women and is most common in their third to fifth decades of life. It occurs more frequently in females, accounting for more than 60% of cases.
The pathophysiology of herniated discs is thought to be a combination of mechanical compression of the nerve by the bulging nucleus pulposus and a chemical process in the form of local increase in inflammatory cytokines. Compressive forces can result in varying degrees of microvascular damage, which can range from mild compression producing obstruction of venous flow that causes congestion and edema, to severe compression, which can result in arterial ischemia. Herniated disc material and nerve irritation may induce the production of inflammatory cytokines.
Typically, patients with cervical spondylosis complain of neck pain accompanied with shoulder pain as a first symptom which can progress to affect motor power and sensation in the form of tingling and numbness in the extremities and brachialgia.
Clinical Examination is crucial in diagnosing Cervical Spondylosis; Provocative examination tests include Spurling Sign, Hoffman Sign, and L’hermitte sign. Spurling test can help diagnose acute radiculopathy while Hoffman test and L’hermitte sign can be used to assess for the presence of spinal cord compression and myelopathy.
Imaging play an important role in confirming diagnosis of cervical disc prolapse, and is vital in indicating role of surgery.
Modalities vary ranging from simple Xray to detect spondylotic changes upto CT spine, but MRI on the cervical spine remains the Gold standard for detecting disc bulge or herniation for it’s sensitivity to soft tissue structures.
Conservative management is the first line in management of cervical spondylosis as 75-90 % of patients will improve.
Modalities of conservative management vary widely;
Neck collar is specially useful during acute phase of inflammatory period as it plays an important role in limitation of movement
Pharmacotherapy and Physiotherapy combined is considered the cornerstone of conservative management.
Indications for surgical intervention include severe or progressive neurological compromise and significant pain that is refractory to conservative measures. There are several techniques described based on pathology. The gold-standard remains the anterior cervical discectomy with fusion, as it allows the removal of the pathology and prevention of recurrent neural compression by performing a fusion;
Anterior cervical discectomy and fusion (ACDF) is a surgical operation to treat nerve root or spinal cord compression by decompressing them through discectomy and inter-vertebral fusion.
The aim of this study was to compare the outcome and prognosis regarding using plates with Anterior Cervical Discectomy and Cage Fusion or without using Plates.
This study was conducted on 20 patients with cervical disc prolapse who were admitted to Minia University Hospital from period of March 2020 to September 2021 and were reviewed retrospectively. 10 of the patients underwent anterior cervical discectomy and cage fusion with plate insertion. 10 of the patients underwent anterior cervical discectomy and cage fusion without plate insertion.
The results of our present study can be summarized as follows:
In our study, patients who underwent ACDF without plate were 10 patients ranging from (30-63) with mean age 47.5 and Patients who underwent ACDF with plate fixation ranging from (38-65) with mean age 52; thus most of our patients were of middle age group in contrast with Cervical Canal stenosis which mainly affects older age groups (Mean 60).
Patients who underwent ACDF without plate were 10 patients 5 male and 5 female, and patients who underwent ACDF with plate fixation were 70% male and 30% female; thus revealing male predominance which may be explained by the harder working life styles of males when compared to females.
All our patients were presented with Neck Pain. 17 of them complained of Brachialgia (7 were right Brachialgia, 6 were left Brachialgia, and 4 were Bilateral Brachialgia) with the remaining 3 complaining of myelopathy and it was noted that the 3 patients who complained of Myelopathy had Cord Signal which wasn’t present in the remaining patients.
In our study, according to affected levels: Patients who underwent ACDF with cage only were as follows: 9 had double level cervical disc prolapse (4 of them had C4-5, C5-6 prolapse and the remaining 5 had C5-6, C6-7 prolapse) and the only 1 patient who underwent ACDF without plate fixation had 3 level disc prolapse (cause he can’t afford the plates). Patients who underwent ACDF with cage-plate construct were as follows: 5 had double level cervical disc prolapse (2 of them had C4-5, C5-6 prolapse and the remaining 3 had C5-6, C6-7 prolapse) and the remaining 5 patients had 3 level disc prolapse.
In our study, according to vas neck pain preoperative, immediate post-operative & 6 months post-operative, as regards to patients who underwent ACDF without plate: Mean score of patients pre-operative was 5.8 ranging from 4-8 and improved to 3.9 (range 1-6) immediately post-operative and 1.9 (range 1-3) six months post-operative. As regards to patients who underwent ACDF with plate: Mean SD of patients pre-operative was 4.4 ranging from 3-7 and improved to 3.4 (range 1-6) immediately post-operative and 1.5 (range 1-2) six months post-operative with no significant difference between the two groups.
In our study, according to vas arm pain preoperative, immediate post-operative & 6 months post-operative: As regards to patients who underwent ACDF without plate: Mean SD of patients pre-operative was 6.1 ranging from 4-9 and improved to 1.8 (range 1-2) immediately post-operative and 1.4 (range 1-2) six months post-operative. As regards to patients who underwent ACDF with plate: Mean SD of patients pre-operative was 6.2 ranging from 5-9 and improved to 1.2 (range 1-2) immediately post-operative and 1.7 (range 1-2) six months post-operative
In this study, according to dysphagia (immediate & 6 months post op) 30% of patients suffered from immediate post-operative dysphagia, but in 6 months follow up this value decreased significantly. In the 6 months follow up no patients of group A had any residual dysphagia while patient of group B reported 1 patient who had residual dysphagia which can be explained by the fact that in plate fixation we needed more exposure thus causing more lateral dissection and manipulation
The current study showed that, only one patient complained of hoarseness of voice in cage only patients while 2 of the cage-plate construct complained of hoarseness of voice; which can be explained by the fact that in plate fixation we needed more exposure thus causing more lateral dissection and manipulation.
Grading of Fusion was considered according to Bridwell inter-body fusion grading system showed that in patients who underwent ACDF without cage had fusion of Grade 1 in 70% and Grade 2 in 30% of the patients while patients who underwent ACDF with plate insertion had Fusion Grade 1 in 90% of patients and Grade 2 in the rest (after 6 months follow up) p=0.264.
In this study, cage subsidence occurred in 1 patient of the cage only patients.
In the current study, malposition of screw in plate occurred in only one patient of the cage- plate construct and was managed conservatively.
Our results revealed that adjacent level occurred in 1 patient at the 6 month follow up in the group of cage-plate construct and was managed conservatively In this study, according to operative time: Patients who underwent ACDF with cage only had operative time ranging from 1.5h to 2.15h with mean 1.83, while patients who underwent ACDF with plate fixation ranged from 1.5h to 2.75h with mean =2. The difference showed no statistical significance (p=0.165) which can be explained by the fact that in plate fixation we needed more exposure thus causing more lateral dissection and manipulation.
Patients who underwent ACDF with cage only had blood loss ranging from 100-250 ml with mean 170 while patients who underwent ACDF with cage plate complex had blood loss ranging 150-250 ml with mean 185, though the difference showed no statistical significance (p=0.347) which can be explained by the fact that in plate fixation we needed more exposure thus causing more lateral dissection and manipulation.
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