Comparison of anterior and posterior surgical approaches in multi-level cervical spondylotic myelopathy

Authors

  • Paruvakkattil Kunjan Balakrishnan Department of Neurosurgery, GMC, Kottayam, Kerala, India
  • Tinu R. Abraham Department of Neurosurgery, GMC, Kottayam, Kerala, India
  • Ajax John Department of Neurosurgery, GMC, Kottayam, Kerala, India

DOI:

https://doi.org/10.18203/2349-2902.isj20213131

Keywords:

Cervical spondylotic myelopathy, ACDF, Corpectomy

Abstract

Background: Cervical spondylotic myelopathy (CSM) is one of the most common dysfunctions of spinal cord which occurs due to degenerative changes in cervical spine disc and facet joints. The management of multilevel spondylotic myelopathy is always controversial. The posterior approaches are always preferable in multiple level spondylosis. But according to newer studies, anterior approaches have similar results. Aim of the study was to compare the efficacy of posterior and anterior approaches in multilevel cervical myelopathy.

Methods: This study includes all patients with multilevel cervical spondylotic myelopathy who have undergone decompression surgery with fusion. Detailed preoperative and post-operative assessment was done according to modified Japanese Orthopedic Association scoring system.

Results: Eighty eight patients of CSM surgical cases were selected for this study and 29 cases of multi-level CSM were observed. And they were randomly selected for anterior and posterior approaches. Sixteen cases anterior approach was done either ACDF or Corpectomy with fusion. Mean age of study was 51.63 years with 64 males and 24 females. The spinal cord level at which most surgeries did was C5/6, 62 cases. While at level C4/5, it was 49 and at level C3/4 and C6/7, it was 35 and 36 respectively.

Conclusions: Both anterior approach and posterior approaches were associated with betterment in postoperative neurological function for multilevel CSM. And there is no significant advantage in doing anterior approach in multilevel CSM.

References

Binder AI. Cervical spondylosis and neck pain. BMJ. 2007;334(7592):527-31.

Vernon H. The Neck Disability Index: state-of-the-art, 1991-2008. J Manipulative Physiol Ther. 2008;31(7):491-502.

Sharma A, Kishore H, Singh V. Comparative Study of Functional Outcome of Anterior Cervical Decompression and Interbody Fusion With Tricortical Stand-Alone Iliac Crest Autograft Versus Stand-Alone Polyetheretherketone Cage in Cervical Spondylotic Myelopathy. Global Spine J. 2018;8(8):860-5.

Singrakhia MD, Malewar NR, Deshmukh S, Deshmukh SS. Prospective Analysis of Functional Outcome of Single-Stage Surgical Treatment for Symptomatic Tandem Spinal Stenosis. Indian J Orthop. 2019;53(2):315-23.

Leak AM, Cooper J, Dyer S, Williams KA, Turner-Stokes L, Frank AO. The Northwick Park Neck Pain Questionnaire, devised to measure neck pain and disability. Br J Rheumatol. 1994;33(5):469-74.

Zhang RJ, Shen CL, Zhang JX. Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients of different ages: a retrospective study. Spinal Cord. 2018;56(1):7-13.

Clarke E, Robinson PK. Cervical myelopathy: a complication of cervical spondylosis. Brain. 1956;79(3):483-510.

Ebersold MJ, Pare MC, Quast LM. Surgical treatment for cervical spondylitic myelopathy. J Neurosurg. 1995;82(5):745-51.

Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis. Spine (Phila Pa 1976). 2015;40(12):675-93.

Morio Y, Teshima R, Nagashima H, Nawata K, Yamasaki D, Nanjo Y. Correlation between operative outcomes of cervical compression myelopathy and mri of the spinal cord. Spine (Phila Pa 1976). 2001;26(11):1238-45.

Cusick JF. Pathophysiology and treatment of cervical spondylotic myelopathy. Clin Neurosurg. 1991;37:661-81.

Wiberg J. Effects of surgery on cervical spondylotic myelopathy. Acta Neurochir (Wien). 1986;81(3-4):113-7.

Yonenobu K, Oda T. Posterior approach to the degenerative cervical spine. In: Aebi M, Gunzburg R, Szpalski M (eds). The Aging Spine. Springer, Berlin, Heidelberg. 2005.

Wada E, Suzuki S, Kanazawa A, Matsuoka T, Miyamoto S, Yonenobu K. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years. Spine (Phila Pa 1976). 2001;26(13):1443-7.

Liu T, Xu W, Cheng T, Yang HL. Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review. Eur Spine J. 2011;20(2):224-35.

Ghogawala Z, Martin B, Benzel EC, Dziura J, Magge SN, Abbed KM, et al. Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy. Neurosurgery. 2011;68(3):622-30.

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Published

2021-07-28

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Original Research Articles