title: Surgical treatment of cervical spondylotic myelopathy with anterior compression: a review of 67 cases.
abstract: OBJECTIVE
  In patients with cervical spondylotic myelopathy (CSM), ventral disease and loss of cervical lordosis are considered to be relative indications for anterior surgery. However, anterior decompression and fusion operations may be associated with an increased risk of swallowing difficulty and an increased risk of nonunion when extensive decompression is performed. The authors reviewed cases involving patients with CSM treated via an anterior approach, paying special attention to neurological outcome, fusion rates, and complications.
  
  
  METHODS
  Retrospectively, 67 cases involving consecutive patients with CSM requiring an anterior decompression were reviewed: 46 patients underwent anterior surgery only (1-to3-level anterior cervical discectomy and fusion [ACDF] or 1-level corpectomy), and 21 patients who required > 3-level ACDF or > or = 2-level corpectomy underwent anterior surgery supplemented by a posterior instrumented fusion procedure.
  
  
  RESULTS
  Postoperative improvement in Nurick grade was seen in 43 (93%) of 46 patients undergoing anterior decompression and fusion alone (p < 0.001) and in 17 (81%) of 21 patients undergoing anterior decompression and fusion with supplemental posterior fusion (p = 0.0015). The overall complication rate for this series was 25.4%. Interestingly, the overall complication rate was similar for both the lone anterior surgery and combined anterior-posterior groups, but the incidence of adjacent-segment disease was greater in the lone anterior surgery group.
  
  
  CONCLUSIONS
  Significant improvement in Nurick grade can be achieved in patients who undergo anterior surgery for cervical myelopathy for primarily ventral disease or loss of cervical lordosis. In selected high-risk patients who undergo multilevel ventral decompression, supplemental posterior fixation and arthrodesis allows for low rates of construct failure with acceptable added morbidity.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Beril
authors.initials: B
authors.lastname: Gok
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Gregory S
authors.initials: GS
authors.lastname: McLoughlin
authors.forename: Matthew
authors.initials: M
authors.lastname: McGirt
authors.forename: Selim
authors.initials: S
authors.lastname: Ayhan
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham