Comparison of Anterior Cervical Decompression Fusion and Expansive Open Door Laminoplasty for Multilevel Cervical Spondylotic Myelopathy

Purpose: Using anterior cervical decompression fusion (ACF) or expansive open door laminoplasty (EOLP) for multilevel cervical spondylotic myelopathy (MCSM) continues to be the subject of considerable debate. Methods: We collected 132 consecutive patients (36 patients for ACF group and 96 patients for EOLP group) at our institution from 2005 to 2011. Preoperative data of both groups were compared. Functional recovery rates, radiographic changes, and complications of the two groups were analyzed. Results: There were no significant difference over age, Japanese orthopedic association (JOA) score, existence of myelomalacia, and cervical range of motion (ROM) between ACF and EOLP groups (p ＞ 0.05). Preoperative Pavlov ratio, axial and sagittal compressive ratios were significant smaller in EOLP and preoperative cervical curvature was less lordotic with more neck pain cases in ACF group (p ＜ 0.05). In ACF group, 1 year functional recovery rate is 83.71 ± 15.61 and Nurick score also significantly improved. Neck pain visual analogue scale (VAS) decreased at postoperative 2 weeks and 3 months. Cervical lordotic angle increased and cervical ROM decreased at postoperative 12 months. Complications include 1 temporary odynophagia, 1 temporary dysphonia, 1 screw loosening, 1 allograft malposition, 1 fusion collapse and 1 pseudarthrosis cases. In EOLP group, 1 year functional recovery rate is 70.22 ± 21.25% and Nurick score also greatly improved. Neck pain VAS increased at postoperative 2 weeks and then decreased at 3 months. Cervical lordotic angle decreased at postoperative 12 months. Cervical ROM decreased at postoperative 3 months and then restored to preoperative degrees at postoperative 12 months. Complications include 5 aggravated neck pain and 3 reversible C5 nerve palsy cases. Conclusion: EOLP had good effect on more stenotic type and ACF benefited painful and kyphotic type MCSM. Both ACF and EOLP are effective procedures for MCSM, depending on adequate patient selection.