Multiple level anterior cervical discectomy and fusion versus posterior laminectomy for the management of multilevel cervical spondylotic myelopathy: clinical and radiological outcome

摘要

Though both anterior and posterior approach are used for the management of multilevel cervical spondylotic myelopathy (CSM), the choice between both approaches remains to be of considerable debate. The aim of the study was to evaluate the clinical and radiographic outcomes of patients with multiple level CSM who underwent posterior laminectomy (PL) versus anterior cervical discectomy and fusion (ACDF). This is a retrospective comparative study of 30 patients, with multiple level CSM managed by the authors, either by PL (n?=?15) or ACDF (n?=?15). Clinical outcome was assessed at 1, 3, 6, and 12?months postoperatively using the modified Japanese Orthopedic Association scale (mJOA) while the postoperative radiographic changes represented by the Cobb’s angle variation was recorded at 12?months postoperatively and compared with preoperative values. Also, the incidence of postoperative complications and neurological deterioration was recorded and studied between the two groups. Study duration was for 2?years from December 2014 to December 2016. Both the ACDF and PL groups showed an improvement in the mJOA score mean value at 1?year after surgery in comparison with the preoperative evaluation data; however, on comparing between both groups at 1?year postoperatively, the median percent of increase in mJOA score was significantly higher in the ACDF group compared with the PL group (33.3% vs 22.2% respectively). On the other hand, the Cobb’s angle percent of change 1?year after surgery showed a median percent of increase of 18.7% in the ACDF group in contrast to a median decrease of ??11.1% in the PL group which was statistically significant. Minimal complications were reported in both groups. Both PL and ACDF are effective modalities for the surgical management of multilevel CSM showing good clinical outcome; however, when compared with the posterior approach, there was a statistical significant difference favoring ACDF regarding the median percent of increase in mJOA score and the postoperative Cobb’s angle improvement.