A Comparison of Clinical and Functional Outcomes Following Anterior, Posterior, and Combined Approaches for the Management of Cervical Spondylotic Myelopathy

Abstract

Background: The key determinants when planning surgery in patients with CSM are the direction of compression, number of levels, sagittal alignment and instability. However there is no literature that compares the clinical and functional outcomes following different approaches in patients selected for surgery.

Aims: Prospective non-randomized study that aims to compare the clinical and functional outcomes following surgical approaches with the goal of planning the optimal surgical strategy.

Material and methods: 75 patients- 61 males and 14 females (mean age: 64.2 years) with CSM underwent spinal decompression using an anterior (30), posterior (35) or combined approach (10).The surgical approach was selected based on the above mentioned key determinants. Functional disability was measured using the modified Japanese Orthopaedic Association score for myelopathy. Based on this the recovery rate was calculated. The mean followup duration was 21 months (range 6-72 months).

Results: The preoperative mJOA score was 11.01 and the functional disability was graded as mild in 15, moderate in 50 and severe in 10. Postoperatively, the mJOA score improved to 16.41.The overall recovery rate was 77.25%.Patients with mild deficits/disability preoperatively had a significantly better recovery (<0.01) than those with more severe disability. There was comparable improvement in the functional status within the groups with the recovery rates were 83.37%, 76.6% and 64.13%.The blood loss, operative time and peri-operative complication rate were significantly higher with a combined surgery (33%) as compared to anterior (13.3%) or posterior approaches 14.8%.

Conclusions: Outcomes are excellent following surgery for CSM.The best recovery is seen in patients with mild to moderate functional disability at the time of surgery.

Keywords: Cervical spondylotic myelopathy; functional outcomes; surgical approach.

Figure 1

65y M with myelopathy secondary to spondylosis- treated with anterior cervical discectomy and fusion at two levels

Figure 2

Multilevel spondylosis resulting in CSM in 67y male treated with corpectomy and plate fixation

Figure 3

64 year male with multilevel cervical spondylosis, overall straight spine and large anterior stabilizing osteophytes resulting in CSM treated with posterior laminectomy

Figure 4

Multilevel spondylosis with instability resulting in CSM in 56 year female treated with posterior laminectomy and fixation