Comparative Study between Anterior and Posterior Approaches in the Management of Cervical Spondylotic Myelopathy

Abstract

Background data: The best surgical approach for managing degenerative cervical myelopathy (DCM) remains debatable. Any surgical intervention for DCM aims to provide decompression of adequate neural elements and preserve mechanical stability with the least morbidity and the best long-term outcome. Due to the heterogeneous nature of DCM, multiple approaches and interventions can be used. Purpose: This study aims to compare anterior cervical discectomy and fusion (ACDF) and posterior laminectomy with and without lateral mass fi xation (LMF) in the treatment of DCM regarding radiological and clinical outcomes. Study design: This is a retrospective, case series study. Patients and methods: Twenty patients who underwent ACDF and 20 patients who underwent cervical laminectomy with and without LMF were recruited in this study. Modi fi ed Japanese Orthopedic Association (mJOA) score and myelopathy scale (MS) were used for clinical assessment. Postoperative complications, recovery rate, and operative blood loss are recorded. The cervical curve and canal diameter were assessed. Results: A total of 40 patients were recruited in this study, including 33 males and seven females, with a mean age of 58.8 ± 10.27 years. There was signi fi cant improvement in cervical angle in the anterior group (19.38 ± 3.5 vs. 16.5 ± 6.4, P ¼ 0.043) and canal diameter in the posterior group (9.5 ± 0.76 vs.11.1 ± 1.98, P ¼ 0.01). There were no signi fi cant differences between both groups on the mJOA scale (13.5 ± 4.16 vs. 12.1 ± 1.7, P ¼ 0.197), MS (5.1 ± 1.6 vs. 5.5 ± 1.07, P ¼ 0.341), and complication rate ( P ¼ 0.14). Conclusion: Our data suggest that both anterior and posterior approaches were equivalent in treating DCM. Each case should be evaluated carefully to determine the best surgical approach.