Short-term and long-term effects of anterior and posterior surgical approaches on plantar pressure distribution in patients with cervical spondylotic myelopathy.

Objective: To compare the short-term and long-term effects of Anterior Cervical Discectomy and Fusion (ACDF) versus posterior open-door laminoplasty on plantar pressure distribution in patients with Cervical Spondylotic Myelopathy (CSM).

Methods: A total of 156 CSM patients admitted between January 2020 and December 2022 were enrolled and divided into an ACDF group (n = 82) and a posterior open-door group (n = 74) based on surgical approach. Plantar pressure data (medial foot pressure, lateral foot pressure, forefoot pressure, rearfoot pressure) were collected preoperatively, at 6 months postoperatively, and at 2 years postoperatively. Concurrent assessments included the mJOA score, Nurick grade, and radiographic parameters (Maximum Spinal Cord Compression ratio, Compression Ratio, Spinal Cord Occupation Ratio).

Results: No significant differences existed in preoperative plantar pressure or clinical indicators between the two groups (P > 0.05). At 6 months postoperatively, medial foot pressure in the ACDF group decreased significantly from (45.21 ± 6.32) % to (38.76 ± 5.14)%, outperforming the posterior group (42.35 ± 5.87)% (P < 0.01). Lateral foot pressure increased to (57.23 ± 4.98)% in the ACDF group versus (55.12 ± 5.36)% in the posterior group (P < 0.05). At 2 years postoperatively, lateral foot pressure in the posterior group further increased to (59.47 ± 5.02)%, partially surpassing the ACDF group (58.15 ± 4.79)% (P = 0.036). However, medial foot pressure improvement remained significantly greater in the ACDF group (36.54 ± 4.82 vs. 39.21 ± 5.16, P < 0.01). Forefoot pressure increased significantly in both groups at 2 years (P < 0.05), while rearfoot pressure showed no significant difference. The ACDF group demonstrated superior improvement in mJOA score (5.21 ± 1.34 vs. 3.89 ± 1.27, P < 0.01) and Nurick grade.

Conclusion: ACDF surgery provides faster and more sustained improvement in medial plantar pressure for CSM patients, correlating with its direct relief of ventral spinal cord compression and restoration of proprioceptive conduction. Posterior surgery may optimize lateral foot pressure through long-term biomechanical compensation of spinal stability, but overall functional recovery is less pronounced compared to the anterior approach.