Abstract
ObjectiveThe optimal surgical treatment for multilevel cervical spondylotic myelopathy (MCSM) remains controversial. This study compared the outcomes of three surgical approaches for MSCM treatment, focusing on the efficacy and safety of a combined approach.MethodsThis retrospective study included 153 consecutive MCSM patients (100 men, 53 women; mean age ± standard deviation, 55.7 ± 9.4 years) undergoing operations involving ≥3 intervertebral segments. The patients were divided into three groups according to surgical approach: anterior (n = 19), posterior (n = 76), and combined (n = 58). We assessed demographic variables, perioperative parameters, and clinical outcomes ≥12 months after surgery (20.5 ± 7.6 months), including Japanese Orthopaedic Association (JOA) score, improvement, recovery rate, and complications.ResultsThe anterior group had the most favorable preoperative conditions, including the highest preoperative JOA score (12.95 ± 1.86, p = 0.046). In contrast, the combined group had the highest occupancy ratio (48.0% ± 11.6%, p = 0.002). All groups showed significant neurological improvement at final follow-ups, with JOA recovery rates of 59.7%, 54.6%, and 68.9% in the anterior, posterior, and combined groups, respectively (p = 0.163). After multivariable adjustments, the groups did not have significantly different clinical outcomes (postoperative JOA score, p = 0.424; improvement, p = 0.424; recovery rate, p = 0.080). Further, subgroup analyses of patients with occupancy ratios ≥50% showed similar functional outcomes following the posterior and combined approaches. Overall complication rates did not differ significantly among the three approaches (p = 0.600). Occupancy ratios did not have a significant negative influence on postoperative recovery following the posterior approach.ConclusionsIf applied appropriately, all three approaches are effective for treating MCSM. All three approaches had equivalent neurological outcomes, even in subgroups with high occupancy ratios. Further investigations of surgical approaches to MCSM are needed, particularly prospective multicenter studies with long-term follow-up.
Highlights
All three approaches are effective for treating multilevel cervical spondylotic myelopathy (MCSM)
Cervical spondylotic myelopathy (CSM) is a common degenerative disease that is characterized by compressions in the cervical region of the spine and results in progressive neural cell loss and neurological deterioration in around 20% to 60% of patients [1]
A preliminary cohort of 163 consecutive MCSM patients were included in the present study, based on the following criteria: (1) clinically and radiographically confirmed CSM, with or without ossification of the posterior longitudinal ligament (OPLL); and (2) at least 3 intervertebral segments included in the operation [11, 12]
Summary
Cervical spondylotic myelopathy (CSM) is a common degenerative disease that is characterized by compressions in the cervical region of the spine and results in progressive neural cell loss and neurological deterioration in around 20% to 60% of patients [1]. Several studies have described different surgical strategies for CSM, the optimal surgical choice for multilevel cervical spondylotic myelopathy (MCSM, 3 or more intervertebral segments involved) remains undetermined [4]. Previous studies of the anterior, posterior, and combined surgical approaches have suggested that the combined approach may offer the best neurological outcomes without significantly increasing complications [7]. The combined approach’s major disadvantages include its technical complexity, prolonged surgical times, and increased blood loss [8]. Abumi [9] and Riew [10] suggest performing surgery with a posterior approach, waiting for 2 or 3 weeks, and performing surgery with an anterior approach, if needed
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