Abstract
BackgroundThough both anterior and posterior approach are used for the management of multilevel cervical spondylotic myelopathy (CSM), the choice between both approaches remains to be of considerable debate.Aim of the workThe aim of the study was to evaluate the clinical and radiographic outcomes of patients with multiple level CSM who underwent posterior laminectomy (PL) versus anterior cervical discectomy and fusion (ACDF).MethodsThis is a retrospective comparative study of 30 patients, with multiple level CSM managed by the authors, either by PL (n = 15) or ACDF (n = 15). Clinical outcome was assessed at 1, 3, 6, and 12 months postoperatively using the modified Japanese Orthopedic Association scale (mJOA) while the postoperative radiographic changes represented by the Cobb’s angle variation was recorded at 12 months postoperatively and compared with preoperative values. Also, the incidence of postoperative complications and neurological deterioration was recorded and studied between the two groups. Study duration was for 2 years from December 2014 to December 2016.ResultsBoth the ACDF and PL groups showed an improvement in the mJOA score mean value at 1 year after surgery in comparison with the preoperative evaluation data; however, on comparing between both groups at 1 year postoperatively, the median percent of increase in mJOA score was significantly higher in the ACDF group compared with the PL group (33.3% vs 22.2% respectively). On the other hand, the Cobb’s angle percent of change 1 year after surgery showed a median percent of increase of 18.7% in the ACDF group in contrast to a median decrease of − 11.1% in the PL group which was statistically significant. Minimal complications were reported in both groups.ConclusionBoth PL and ACDF are effective modalities for the surgical management of multilevel CSM showing good clinical outcome; however, when compared with the posterior approach, there was a statistical significant difference favoring ACDF regarding the median percent of increase in mJOA score and the postoperative Cobb’s angle improvement.
Highlights
Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction that can substantially decrease quality of life [1]; it may manifests with a variety of findings including difficulty with gait or balance, sphincteric control disturbances, motor weakness, sensory changes, and abnormal reflexes [2, 3]
Imaging of cervical spondylotic myelopathy (CSM) consists of plain radiographs with flexion and extension views to evaluate cervical spine stability, while magnetic resonance imaging (MRI) of the cervical spine remains the most important modality to evaluate the soft tissues about the spine and the spinal cord [3, 4]
Thirty patients were enrolled in this study; they were divided according to surgical approach into two groups, the Anterior cervical discectomy and fusion (ACDF) group (15 patients) and the posterior laminectomy (PL) group (15 patients), who were followed up for 12 months after surgery
Summary
Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction that can substantially decrease quality of life [1]; it may manifests with a variety of findings including difficulty with gait or balance, sphincteric control disturbances, motor weakness, sensory changes, and abnormal reflexes [2, 3]. Whether discectomy or corpectomy, are mostly used for younger patients, whereas posterior approaches, whether laminectomy or laminoplasty, are frequently offered for older patients with preserved lordosis who are poor candidates for fusion, and except for the risk for intraoperative recurrent laryngeal nerve injury as a distinct complication of the anterior approach, other complications, such as infection and postoperative neurological dysfunction, are relatively comparable [3, 10] Though both anterior and posterior approach are used for the management of multilevel cervical spondylotic myelopathy (CSM), the choice between both approaches remains to be of considerable debate
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
