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. 2015 Feb;11(1):15-25.
doi: 10.1007/s11420-014-9408-6. Epub 2014 Aug 8.

Anterior surgical treatment of cervical spondylotic myelopathy: review article

John C Quinn  1 , Paul D Kiely  1 , Darren R Lebl  1 , Alexander P Hughes  1
Affiliations

Anterior surgical treatment of cervical spondylotic myelopathy: review article

John C Quinn et al. HSS J. 2015 Feb.

Abstract

Background: Cervical spondylotic myelopathy (CSM) is a common indication for cervical spine surgery. Surgical options include anterior, posterior, or combined procedures each with specific advantages and disadvantages.

Questions/purposes: This article will provide a description of the various anterior alternatives and discuss the available evidence used in guiding the surgical decision making process with the aim of answering the following questions: (1) What anatomical/disease related factors favor anterior over posterior surgeries? (2) What are the common anterior procedures and how safe and effective are they? (3) What are the most effective options for multilevel CSM? (4) Is there a role for motion preservation? An additional objective is to discuss technical advances that have improved success rates for anterior procedures.

Methods: The PubMed database was searched. Keywords were CSM and anterior surgery. Three hundred eighty two articles were found one hundred three were reviewed. Articles describing anterior cervical techniques were selected along with studies describing the various anterior techniques or comparisons of anterior to posterior techniques.

Results: Anterior decompression and fusion procedures are more effective than posterior procedures for patients with primarily ventrally located compression especially in the presence of cervical kyphosis. ACDF, ACCF, and hybrid combinations are safe and effective treatment options for multilevel CSM. Anterior procedures may be more cost effective and result in significantly improved postoperative quality of life and health-related quality of life measures compared to posterior procedures.

Conclusion: Anterior cervical decompression techniques are safe and effective in the treatment of CSM. Anterior surgeries may be preferable to posterior approaches, when considering health-related quality of life measures and cost effectiveness.

Keywords: anterior cervical fusion techniques; anterior surgery; cervical spondylotic myelopathy.

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Figures

Fig. 1
Fig. 1
Illustrative case. A 38-year-old man with progressive neck pain, myelopathy, and C7 radiculopathy. a Sagittal T2-weighted magnetic resonance imaging scan (MRI) demonstrating multilevel cervical disc degeneration and spinal cord compression at C4–5, C5–6, and C6–7 with intramedullary T2-weighted signal changes at C6–7 interspace. b Lateral radiograph showing diffuse arthrosis and loss of cervical lordosis. c Postoperative radiograph following 3-level ACDF (C4–C7) with anterior plating demonstrating restoration of lordosis.
Fig. 2
Fig. 2
Anterior cervical reconstruction techniques for multilevel CSM. Lateral cervical spine radiographs demonstrating anterior reconstruction techniques for multilevel CSM. a 4-level anterior cervical discectomy and fusion (ACDF). b 2-level anterior corpectomy and fusion (ACCF). c Hybrid ACDF-ACCF construct. d Hybrid cervical disc replacement (CDR)-ACDF construct.
See this image and copyright information in PMC

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