Clinical Outcome of Anterior vs Posterior Approach for Cervical Spondylotic Myelopathy

Abstract

Introduction Cervical spondylotic myelopathy is a common cause of neurological morbidity. The decompression of the neural elements is the gold standard procedure for this pathology, but there is still a lot of controversy for the selection of the approach, anterior, posterior or combined. Methods 42 patients were enrolled with the diagnosis of cervical spondylotic myelopathy, the 42 underwent surgery with either anterior or posterior approach at the hospital Centro Médico Nacional de Occidente, Guadalajara, México, a follow up for up to one year was made, comparing the results with the modified score for the Japanese Association of Orthopaedics (mJAO) and the Nurick score. Results Patients were divided into two groups. homogeneity analysis were made, finding similar results between both groups ( p < 0.05) Group A. 19(45%)patients received surgery by an anterior approach (Corpectomy with expandable cage and anterior plate fixation) and group B. 23 (55%)underwent posterior approach, from this 23 patients, 18(43%) had a laminectomy with posterior instrumentation and fusion, and 5 (12%) had a laminoplasty. 38% female patients and 62% male patients, median age was 75 years old. Functional outcomes were measure with the modified score for the Japanesse Association of Orthopaedics (mJAO) for up to one year follow up. Group A had a lower score (x:15.52) compare with group B (x:17.13) (15.52 versus 17.13, p < 0.05. While in the Nurick score Group B got a higher score (x:0.73) compare with group A (x:0.30) (0.73 vs 0.30, p < 0.05). Conclusions The election of the surgical approach in the cervical spondylotic myelopathy should be individualize according to the characteristics of the injured elements, it should be focused in the decompression of the neural elements and the recovery to the sagittal balance. In this study a statistical difference was found according to the mJAO and the Nurick scale in favor of the posterior approach, but the anterior decompression may also have good results according to the one year follow up ( p < 0.05). More studies should be made with a bigger population and a longer follow up