We evaluated the results of the Robinson method of anterior cervical
discectomy and arthrodesis with use of autogenous iliac-crest bone graft,
at one to four levels, in 122 patients who had cervical radiculopathy. A
one-level procedure was done in sixty-two of the 122 patients; a two-level
procedure, in forty-eight; a three-level procedure, in eleven; and a
four-level procedure, in one. The average duration of clinical and
roentgenographic follow-up was six years (range, two to fifteen years). The
average age was fifty years (range, twenty-five to seventy-eight years).
Preoperatively, 118 patients had pain in the arm, fifty-five had weakness
of one or more motor roots, and seventy-seven had sensory loss. At the time
of follow-up, eighty-one patients had no pain in the neck, twenty-six had
mild pain in the neck, nine had moderate pain in the neck, four had mild
radicular pain, and two had a combination of mild radicular pain and
moderate pain in the neck. One hundred and eight patients had no functional
impairment, and fourteen had a slight limitation of function during the
activities of daily living. Nine of eleven patients who had symptoms
related to a change at one level cephalad or caudad to the site of a
previous arthrodesis had another operative procedure. Lateral
roentgenograms of the cervical spine, made in flexion and extension, showed
a pseudarthrosis at twenty-four of 195 operatively treated segments.
Sixteen of the patients who had a pseudarthrosis were symptomatic, but only
four had sufficient pain to warrant revision. The risk of pseudarthrosis
was significantly greater after a multiple-level arthrodesis than after a
single-level arthrodesis (p < 0.01). At the time of the most recent
follow-up, fifty-three of the fifty-five patients who had had a motor
deficit had had a complete recovery, and the two remaining patients had had
a partial recovery. Seventy-one of the seventy-seven patients who had had a
sensory loss had regained sensation. None of the patients had an increased
neurological deficit postoperatively. Our results suggest that the Robinson
anterior cervical discectomy and arthrodesis with an autogenous iliac-crest
bone graft for cervical radiculopathy is a safe procedure that can relieve
pain and lead to resolution of neurological deficits in a high percentage
of patients.