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. 2025 Jun 6;20(1):574.
doi: 10.1186/s13018-025-05976-w.

Lateral position posterior surgery followed by supine position anterior surgery in a single stage (LP-A) for the treatment of cervical spinal cord anterior severe dynamic compression in short-term

Qiang Zhang #  1 , Shunqiang Sun #  2 , Jinkai Liu #  3 , Zequn Zhang  1 , Yuan Xue  4   5   6
Affiliations

Lateral position posterior surgery followed by supine position anterior surgery in a single stage (LP-A) for the treatment of cervical spinal cord anterior severe dynamic compression in short-term

Qiang Zhang et al. J Orthop Surg Res. .

Abstract

Purpose: To evaluate the effectiveness and safety of the lateral position posterior surgery ahead of the anterior surgery (LP-A) in a single stage for releasing the cervical spinal cord from short-term severe anterior compression.

Methods: The severe stenosis with dynamic compression defined as Vaccaro`s system degree 3 or 4 with neurological symptoms aggravation when flexion or extension of the cervical spine. Retrospectively analyzed 64 short-level degenerative cervical myelopathy (DCM) patients from severe compression who underwent posterior cervical decompression in the lateral position ahead of supine anterior decompression and fusion at a single stage.

Results: Sixty-four patients with DCM from severe compression were enrolled. The mean operation time was 183.06 ± 32.42 min. The postoperative mJOA scores of the patients increased from 7.61 ± 0.94 to 14.03 ± 0.78. The expansion degree of the cervical spinal cross-sectional area and drift-back distance rose from 62.05 ± 14.05 to 164.05 ± 37.62mm2 and from 5.08 ± 1.22 to 12.70 ± 1.26, respectively. The Neck Disability Index was 31.81 ± 3.17 before the operation, 20.14 ± 2.22, 17.69 ± 1.56, 15.64 ± 1.51, and 13.70 ± 1.50 at 1, 3, 6, and 12 months after the operation, respectively. The visual analogue scale (VAS) score of the cervical was 5.64 ± 1.01 before the operation, 2.41 ± 0.64, 2.08 ± 0.48, 1.45 ± 0.50, and 1.06 ± 0.47 at 1, 3, 6, and 12 months after the operation, respectively. The sagittal vertical axis (cSVA) and the Cobb angle were significantly changed after surgery.

Conclusion: Posterior cervical decompression in the lateral position ahead of anterior decompression and fusion in a single stage is an effective and safe surgical procedure for the treatment of severe short-term cervical cord anterior compression.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A 44-year-old male patient who underwent the LP-A approach decompression: Poor physiological curvature, C4-6 soft cervical disc herniation, ossification of the posterior longitudinal ligament (OPLL) isolation type. a-b. preoperative view of X-ray; c. preoperative CT scanning; d-g. preoperative MRI; h-i. postoperative view of X-ray; j. preoperative computed CT; k-n. postoperative MRI. After the operation, sufficient decompression was observed
Fig. 2
Fig. 2
A 70-year-old male patient who underwent the LP-A approach decompression: Poor physiological curvature, C4-6 soft cervical disc herniation, severe anterior compression. a-b. preoperative view of X-ray; c. preoperative CT scanning; d-g. preoperative MRI; h-i. postoperative view of X-ray; j. preoperative computed CT; k-n. postoperative MRI. After the operation, sufficient decompression was observed
Fig. 3
Fig. 3
A 67-year-old female patient who underwent the LP-A approach decompression: Poor physiological curvature, C4-5 soft cervical disc herniation, C5-6 hard cervical disc herniation, severe anterior compression. a-b. preoperative view of X-ray; c. preoperative CT scanning; d-g. preoperative MRI; h-i. postoperative view of X-ray; j. preoperative computed CT; k-n. postoperative MRI. After the operation, sufficient decompression was observed
Fig. 4
Fig. 4
A 72-year-old female patient who underwent the LP-A approach decompression: Poor physiological curvature, C3-4 soft cervical disc herniation, severe anterior compression. a-b. preoperative view of X-ray; c. preoperative CT scanning; d-g. preoperative MRI; h-i. postoperative view of X-ray; j. preoperative computed CT; k-n. postoperative MRI. After the operation, sufficient decompression was observed
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