30 Bombay Hospital Journal, Vol. 52, No. 1, 2010 Introduction W hen more than one procedure is performed for the same condition, then it is unlikely that one procedure is clearly the superior one. 1 Posterior cervical decompressive laminectomy for spondylosis was earlier performed for several decades. In the 1950s, anterior cervical discectomy with fusion by Smith-Robinson 2 and Cloward 3 techniques became popular and the mainstay of surgical treatment with some variations. 4-11 Anterior discectomy without fusion was described in 1960 by Hirsch 12 and has been recently reported by several workers 7,10,13-18 with comparable results. These reports have sparked a debate about which of these two methods is better. Several clinical studies have been published with some prospective randomized trials. However, methodological flaws, such as nonhomogeneous patient population, undefined randomization process, small sample sizes, unclear outcome measurements and substantial loss of patients for follow-up preclude definite conclusions regarding the efficacy of ACD versus ACDF. Also, the debate has centred on which procedure is better for all patients rather than which patients would benefit from which procedure. *Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai - 400 020. A Study of Anterior Cervical Discectomy With or Without Fusion Rajiv Kumar*, CE Deopujari*, Rajan Shah*, Ashish Kumar* Abstract Objectives : To retrospectively study and compare the clinical outcome of the patients undergoing anterior cervical discectomy (ACD), anterior cervical discectomy with fusion (ACDF), or anterior cervical discectomy with fusion and instrumentation (ACDFI) for cervical spondylosis. Methods : A retrospective analysis of 80 patients with cervical spondylosis who had undergone anterior cervical discectomy with or without fusion according to our preoperative assessment, were undertaken. Clinical outcome and associated complications in each group were analyzed to determine the need and efficacy of each procedure in these patients. Results : ACD and ACDF group had almost similar results in terms of hospital stay, mean time for improvement and patient satisfaction. ACDFI group had more prolonged hospital stay, took longer time to recover and to return to maximum normal status because of their poorer preoperative neurological status. Conclusions : Fusion is not routinely required, but it is indicated in patients with multisegmental disease, instability, loss of cervical lordosis, hard disc and osteophytic bars. Keys to achieve desirable clinical results are proper patient selection and adequate surgical decompression. No single gold standard procedure exists for the treatment of patients with cervical spondylosis and the treatment strategies need to be tailored to match the specific changes present in a given patient.