[Surgical decompression of cervical arthrotic myelopathies: comparison of surgical anterior and posterior approaches].
OBJECTIVE
Operative treatment of cervical myelopathy has focused on decompression of the spinal cord to avoid neurological deterioration. Anterior or posterior operative techniques have been used to decompress the canal with variable success. The purpose of this study was to compare surgical results after subtotal corporectomy or discectomy with an anterior approach and laminectomy or laminoplasty with a posterior approach.


METHODS
We reviewed 30 patients with cervical spondylolitic myelopathy who had undergone surgery between 1989 and 1998. Mean age was 55.8 years (range 28 to 82). There were 23 men and 7 women. An anterior approach was used for 14 patients to achieve subtotal corporectomy or anterior discectomy with strut grafting. A posterior approach was used in another 14 patients to achieve laminectomy or laminoplasty. Both anterior and posterior approaches were used for two patients. The severity of the pre- and postoperative neurological deficits was assessed with the Nurick scale.


RESULTS
Average follow-up was 35.7 months (range 8 to 120). Neurological status improved in 83% of the patients. Improvement was better for those operated with the anterior approach for pain or brachialgia. The duration of the posterior procedures was, however, shorter with less blood loss. There was no statistical difference between the anterior or posterior approaches for motor function, sensory function, gait anomalies, or complications.


CONCLUSIONS
Surgical treatment is effective in cervical spondylolitic myelopathy. The anterior approach is preferred in case of pain or brachialgia; the posterior approach is indicated in case of poor health status or for bedridden patients.
Goubier
J N
JN
Service de Chirurgie Orthopédique, Traumatologique et Réparatrice de l'Appareil Locomoteur, GH Pitié-Salpétrière, Université Pierre et Marie Curie, 83, boulevard de l'Hôpital, 75013 Paris, France. goubjnal@club-internet.fr
Benazet Dagger
J P
JP
Saillant
G
G
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005684:Gait; D006304:Health Status; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D010003:Osteoarthritis / Q000150:complications*; D018579:Patient Selection; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome