The treatment of symptomatic cervical degenerative disk disease through an anterior transcervical retropharyngeal approach dates back to the late 1950s when the anterior cervical diskectomy and fusion was first described.1'2 Since its inception, the anterior cervical arthrodesis has evolved into the gold standard treatment of symptomatic cervical spondy-losis. Fusion rates for cervical arthrodesis are well over 90%, and more important, the procedure boasts excellent clinical success rates. However, cervical arthrodesis is not without its shortcomings. Fusion of >= 2 cervical vertebrae reduces the physiologic cervical range of motion and increases the bio-mechanical load on the remaining vertebrae, which likely accelerates adjacent-level degeneration.5 Radiographic evidence of adjacent-level disease will eventually be seen in the vast majority of patients after cervical arthrodesis,6 and the rate of symptomatic adjacent-level disease requiring reo-perative is approximately 3% annually.7
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