Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy.

摘要

STUDY DESIGN: A clinical prospective study. OBJECTIVE: To assess whether clinical and radiologic outcomes differ between anterior decompression and fusion (ADF) and laminoplasty (LAMP) in the treatment of cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: No reports to date have accurately and prospectively compared middle-term clinical outcomes after anterior and posterior decompression for CSM. METHODS: We prospectively performed LAMP (n = 50) in 1996, 1998, 2000, and 2002, and ADF (n = 45) in 1997, 1999, 2001, and 2003. The Japanese Orthopedic Association (JOA) score, recovery rate, and each item of the JOA score were evaluated. For radiographic evaluation, the lordotic angle and range of motion (ROM) at C2-C7 and residual anterior compression to the spinal cord (ACS) after LAMP on magnetic resonance imaging were investigated. RESULTS: Eighty-six patients (ADF n = 39; LAMP n = 47) could be followed for more than 5 years (follow-up rate 91.5%). Demographics were similar between the two groups. The mean JOA score and recovery rate in the ADF group were superior to those in the LAMP group from 2-year data collected after surgery. However, LAMP was safer and less invasive than ADF with respect to physical status and complications in the perioperative period. For individual items of the JOA score, the ADF group showed significantly more improvement of upper extremity motor function than the LAMP group (P < 0.05). There was a significant difference in maintenance of the lordotic angle in the ADF group compared with the LAMP group despite no difference in ROM.The LAMP group was divided into two subgroups: (1) LAMP(+) (n = 16) comprising patients who had ACS at 2 years after surgery, and (2) LAMP(-) (n = 31) comprising patients without ACS. Recovery rate differed significantly between the LAMP(+) and LAMP(-) groups despite there being no difference between the LAMP(-) and ADF groups. CONCLUSION: The recovery rate of the JOA score in the ADF group was better than that in the LAMP group. The clinical outcomes after LAMP could be influenced by ACS.