Short-Term Outcomes of Anterior Fusion–Nonfusion Hybrid Surgery versus Posterior Cervical Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy

Abstract

To compare short-term clinical and radiologic outcomes of anterior fusion-nonfusion hybrid surgery (cervical discectomy or corpectomy and fusion combine with cervical disc replacement) and posterior cervical laminoplasty for multilevel cervical spondylotic myelopathy. From January 2014 to December 2015, 105 patients who underwent anterior fusion-nonfusion hybrid surgery (AHS group, n= 48) or posterior cervical laminoplasty (n= 57) for ≥3 disc levels cervical spondylotic myelopathy were included. The Japanese Orthopedic Association (JOA) score, complications, and radiologic results including cervical curvature and cervical range of motion (ROM) were compared between the 2 groups of patients. The complications that occurred within 1 month after the surgery were recorded as early complications, otherwise they were considered late complications. Both groups gained significant JOA scores improvement (P < 0.05). No significant difference in JOA improvement was found between the 2 groups (P > 0.05). The cervical curvature increased significantly in the AHS group (P= 0.024), whereas it decreased significantly in the posterior cervical laminoplasty group (P= 0.002). Cervical ROM of both groups significantly decreased after the surgery (P < 0.05). The preoperative and final follow-up cervical ROM, together with the total cervical ROM preservation rate were not significant different between the 2 groups (P>0.05). The AHS group had a significant higher early complication rate (22/48 vs. 15/57; P= 0.037) and a lower late complication rate (9/48 vs. 21/57; P= 0.041). Both anterior fusion-nonfusion hybrid surgery and cervical laminoplasty could gain satisfied neurological recovery. The anterior hybrid surgery may preserve cervical curvature with a higher early complication rate and a lower late complication rate than cervical laminoplasty.