الفهرس 
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Abstract
This study is a prospective randomized clinical trial, discussing surgical and clinical outcome of anterior cervical discectomy and fusion using cage versus ACDF augmented by plate fixation. The aim of this study was to compare the surgical and clinical outcome of the two techniques. At first, the study reviewed the surgical anatomy of the cervical spine including the anatomy of the cervical vertebrae, intervertebral joints and intervertebral disc. A brief discussion of the musculature of the cervical spine was done, as well as the anatomy of the spinal cord and its roots and the related structures. A short illustration of the biomechanics of the cervical spine was made. The pathophysiology and the biochemical changes of cervical disc herniation were clearly reviewed. The clinical presentation of cervical disc herniation has been discussed including a description of cervical radiculopathy, sensory dermatomes and affection of the cord in form of myelopathy. The radiological investigations of herniated cervical disc were also demonstrated with their advantages, disadvantages and their role in diagnosing the disease. The study also reviewed the measures of conservative management for cervical disc herniation. Detailed discussion of the surgical treatment for cervical disc herniation was done stressing on anterior cervical discectomy and fusion technique and the history of its evolvement. The study also thoroughly reviewed the complications of the surgical management and the measures considered to and avoid and deal with them. The study also illustrated the surgical steps of the two techniques. Also a comparative view between the two technique was adopted with explanation of the advantages and disadvantages of the stand-alone cage technique in relation to the plate augmentation technique. The study included 30 patients with single or multilevel cervical disc herniation which did not respond to conservative treatment. Patients with cervical trauma within the past 4 weeks, cervical spine neoplasia, continuous ossified posterior longitudinal ligament, ongoing cervical infection or those who were medically unfit were excluded. The patients were randomly distributed into two equal groups, one group underwent ACDF with cage only and the other group underwent ACDF augmented with plate fixation. Visual Analogue Score (VAS) and Neck Disability Index (30) were used to evaluate the clinical status of the patients preoperatively and postoperatively. Cervical plain X-ray, CT cervical and MRI cervical spine were done to all the patients preoperatively. Postoperative X-Ray and CT was done to all the patients to demonstrate extent of bony fusion and to exclude pseudo arthrosis. The age of the patients ranged from 33 to 65years in group A, and in group B the age of the patients ranged from 33 to 60 years. Male to female ratio in the cage group was 66:34 and in the plate group was 60:40. Neck pain and brachialgia were the most common presenting complaints occurring in all patients (100%) of both study groups. 3 Patients in the cage group and 2 patients in the plate group was myelopathic and had sensory system affection on examination. In group A, 13.3% of patients had C3-C4 disc herniation, 6.7% had C4- C5 disc herniation, 20% had C5-C6 disc herniation, 26.7% had C6-C7 disc herniation, 6.7% had C4-C5/C5-C6 disc herniation, and 26.7% had C5-C6/C6- C7 disc herniation. In group B, 6.7% of patients had C3-C4 disc herniation, 6.7% had C4-C5 disc herniation, 26.7% had C5-C6 disc herniation, 26.7% had C6-C7 disc herniation, 13.3% had C4-C5/C5-C6 disc herniation, and 20% had C5-C6/C6-C7 disc herniation. The operative time was significantly longer in plate group (mean time 77.0 ± 7.53 minutes for single level and 126.0 ± 9.62 for double level) than in cage group (mean time 66.50 ± 6.69 minutes for single level and 108.0 ± 8.37 for double level). The difference between preoperative and postoperative VAS for neck pain and brachialgia and NDI was insignificant in both groups. Intraoperative blood loss was less in the cage group, however insignificant in both groups. Wrong level exploration, unintended durotomy, vascular and esophageal perforation and root injury were absent from all cases of the study in both groups. Excessive epidural bleeding occurred in 3 cases (20%) in cage group and 4 cases (26.7%) in plate group. Transient dysphagia occurred in 1 case in cage group and 2 cases in plate group. Transient post-operative hoarseness of voice occurred in 1 case in cage group and 3 cases in plate group. Postoperative CSF leak, cage subsidence, pseudo arthrosis, wound infection and worsen of neurological condition were absent from all cases. Postoperative hospital stay was nearly equal in both groups (mean time 1.55 days for group A and mean time 2.25 days for group B). Return to daily activity was equal in both groups.