Contiguous versus skip discectomy and fusion in cervical disc herniation: Do we need to fuse the normal intermediate segment?

Aims and objectives: Noncontiguous degenerative cervical disc disease (NCDDD) is characterized by cervical disc prolapse involving nonadjacent segments. This study aims to determine if skip discectomy and fusion technique compared to contiguous discectomy and fusion while preserving adjacent segment disease in uninvolved intermediate segments leads to equivalent or better clinical and radiological outcomes.

Methods: Fifty-two patients who underwent management of NCDDD and two-level contigious disc disease (CDD) over 6 years from 2014 to 2020 were included in the study. There were 44 male and 8 female patients with a mean age of 46.75 years. These patients were divided into two groups: Those who underwent contiguous discectomy and those who underwent skip discectomy with either anterior cervical discectomy (ACD) alone, ACD and fusion (ACDF), or ACDF with plating based on individual pathology and surgeon preference. Outcomes were assessed using clinical parameters such as modified Japanese Orthopaedic Association Score (mJOAS) and Nurick grade and radiological parameters such as disc height improvement, spinal alignment change, and fusion rates.

Results: The overall mean duration of follow-up was 15.23 ± 23.69 months, with a clinical follow-up period of 23.87 ± 21.51 months and a radiological follow-up period of 7.57 ± 5.91 months, with follow-up in Group 1 being 24.67 ± 23.17 months and in Group 2 being 20.03 ± 10.53 months. The mean blood loss in Group 1 was 200.47 mL; in Group 2, it was 172 mL. The preoperative mJOAS was 10.19 ± 3.16, and the postoperative mJOAS was 12.73 ± 2.92 (P = 0.001). Nurick grade showed improvement from a preoperative mean score of 4.23 ± 1.02-3.65 ± 0.88 postoperatively (P < 0.001). Statistically significant improvement in intervertebral height at superior and inferior levels was observed. Outcomes for Skip discectomy regarding mJOAS, Nurick grade, radiological parameters, fusion, and complication rates were noninferior to contiguous discectomy and fusion.

Conclusion: Skip discectomy has a similar benefit and risk profile and is noninferior compared to contiguous discectomy in addition to the preservation of intermediate disc integrity.