Comparison of clinical outcomes of anterior versus posterior surgery in treating multi-segmental cervical degeneration.

Abstract

The purpose of this study is to compare clinical outcome of different surgical methods in treating multi-segmental cervical degeneration. Three hundred and sixty eight patients with multi-segmental cervical degeneration were retrospectively selected and divided into two groups with 184 cases in each based on different surgical methods: one group accepted surgeries from anterior surgical approach and the other group accepted surgeries from posterior surgical approach. Perioperative parameters including operative time, intraoperative blood loss and length of stay were compared between two groups. Patients were followed up after 1 week, 6 month, 10 months and 1 year after surgery. Cervical X-ray was retaken, and Japanese orthopaedic association (JOA) scores, neck disability index (NDI ) scores and numerical pain rating scale (NPRS ) scores were obtained for comparison. Samples from cervical disc were processed to detect cytokines level including IL-1, IL-6, TNF-α and MMP-3. Perioperative parameters including operative time, intraoperative blood loss and length of stay showed no significant difference (P < 0.05) between the two groups. JOA score, NDI scores and NPRS scores, all showed a significant improvement after the surgery in both methods, however, when comparing the two methods, no significant difference was found between two groups (P > 0.05), except that NDI scores in anterior surgical approach group were significantly lower than posterior surgical approach group at different follow-up time points (P < 0.05). The average height of fused vertebral bodies after surgery in two groups was significantly different from pre-operative height (P < 0.05), and angle loss in posterior surgical approach group was significantly higher than anterior surgical approach (P < 0.05), which was statistically different. Cytokines including IL-1, IL-6, TNF-α and MMP-3 in two groups had no statistical difference (P > 0.05). Anterior approach surgery and posterior approach surgery are both effective methods to treat multi-segmental cervical degeneration. Anterior approach had better clinical outcomes within 1-year follow-up.