Comparison between anterior and posterior decompression for cervical spondylotic myelopathy: subjective evaluation and cost analysis

Abstract

Objective: To compare anterior and posterior approaches for treating cervical spondylotic myelopathy (CSM) involving more than two levels, especially in regard to quality of life and cost effectiveness.

Methods: The authors studied 116 CSM patients who underwent decompressive surgery by either an anterior or a posterior approach with instrumentation. In the anterior group, 1-3 levels subtotal vertebrectomy was followed by bone graft and Orion anterior cervical locking plate fixation. In the posterior group, multilevel laminectomy with posterior screw-rod fixation was performed. Follow-up, which included radiographic assessment, clinical examination and documentation of length of any hospitalization and cost and incidence of complications, was performed 1 day before discharge, 6 months after leaving hospital, and at final follow-up.

Results: Both groups had improved clinical outcomes. The anterior group showed greater satisfaction but lower visual analog scale scores than the posterior group, whereas SF-36 emotional role and mental health scores were higher in the anterior group. There was no marked difference between the two groups in length of hospitalization and most of the costs of treating CSM, however treatment and examination fees were significantly higher in the posterior group.

Conclusions: Both anterior and posterior decompressions (with instrumentation) are effective procedures for improving the neurological outcomes of patients with CSM. However, although the two approaches have similar health care costs, anterior cervical corpectomy (with instrumentation) seems to be subjectively assessed by patients as better.

Figure 1

A 45 year‐old man had 4‐years of intermittent, progressively worsening neck pain combined with weakness in all extremities for 1 year. (A) Preoperative MR imaging shows that the cervical discs have protruded at C3‐4, C4‐5, C5‐6, compressing the spinal cord at the involved levels. (B) A preoperative lateral radiograph shows straightening of cervical lordosis. (C, D) After performing 4‐levels laminectomy with posterior screw‐rod fixation, improvement in intervertebral height and cervical lordosis is apparent.

Figure 2

A 52 year‐old woman had had numbness and weakness in both hands for six months. (A) Preoperative MR imaging shows that the cervical discs have protruded at C4‐5, C5‐6, C6‐7, compressing the spinal cord at the involved levels. (B) A preoperative lateral radiograph shows straightening of cervical lordosis. (C, D) After performing C5 and C6 subtotal vertebrectomy followed by bone graft and fixation, improvement in intervertebral height and cervical lordosis is apparent.

Figure 3

Pie chart showing composition of total costs (including costs of treatment, examination, surgery, medication, and instruments) in (A) the anterior group and (B) the posterior group.