Multilevel Anterior Cervical Fusion Versus Posterior Cervical Laminectomy and Lateral Mass Fixation or laminoplasty for Cervical Spondylotic Myelopathy

Abstract

Background Data: Optimal surgical treatment of cervical myelopathy is timely essential before progressive spinal cord demyelination occurs. Purpose: To compare the neurological outcomes and associated complication of anterior and posterior approaches in the treatment of multilevel cervical spondylotic myelopathy (CSM). Study Design: Retrospective comparative clinical case study. Patients and Methods: Between January 2010 and January 2015, a total of 48consecutive patients with Multilevel CSM were operated in Suez Canal University hospital. Multilevel anterior cervical fusion (ACF) were performed in 25/48 patients, posterior laminectomy lateral mass fixation in 18/48, and laminoplasty in 5/48 patients. All patients had MRI and plain radiographs preoperative and postoperative radiographs. The neurologic status was assessed preoperatively and postoperatively of all patients using the Japanese Orthopaedic Association (JOA) score and modified Nurick disability index (DI) score. Postoperative complication was documented. Regular follow up at 3 months, 6 months, and then yearly after surgery. Results: Preoperative JOA score was (anterior=10.8±2.1, posterior=11.4±2.1), and modified Nurick DI score was (anterior=3.2±0.5, posterior=2.9±0.64).However, thepatients' preoperative radiological imaging using Cobb's angle was lower in the posterior group (posterior=6±3.6; anterior=9.9±4.5).At last follow-up, significant improvements were reported in both groups regarding JOA scores, and Nurick DI score with no significant differences among the two groups with respect to postoperative JOA score (P=0.451), and postoperative Nurick DI (P=0.216). Postoperative Hirabayashi’s recovery was relatively better in anterior than posterior group (anterior, 29.1±19.4%, posterior, 24.6±19.1%). Kyphotic angle improved from 9.9±4.5 to 13±3.3 degree and from 6± 3.6 to 7±3.4 degree in anterior and posterior group respectively. Fusion rate was better in posterior group 13/18 than anterior group 11/25 with significance (P=.081). The overall complication rates of the two groups did not differ significantly (P=0.237). Conclusion: Multilevel CSM with Kyphotic angle can be treated by posterior laminectomy and lateral mass fixation with good fusion and neurological outcome. Instrumented fusion prevents progressive kyphosiswhen laminectomy is used. Laminoplasty is recommended for younger patient to preserve function with no kyphotic progression. Anterior surgery had good outcome in younger patient, lower number of the affected levels, and with less MRI T2 signal changes. (2015ESJ092)