title: Cervical surgical techniques for the treatment of cervical spondylotic myelopathy.
abstract: OBJECTIVE
  The objective of this systematic review was to use evidence-based medicine to compare the efficacy of different surgical techniques for the treatment of cervical spondylotic myelopathy (CSM).
  
  
  METHODS
  The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to anterior and posterior cervical spine surgery and CSM. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.
  
  
  RESULTS
  A variety of techniques have improved functional outcome after surgical treatment for CSM, including anterior cervical discectomy with fusion (ACDF), anterior cervical corpectomy with fusion (ACCF), laminoplasty, laminectomy, and laminectomy with fusion (Class III). Anterior cervical discectomy with fusion and ACCF appear to yield similar results in multilevel spine decompression for lesions at the disc level. The use of anterior plating allows for equivalent fusion rates between these techniques (Class III). If anterior fixation is not used, ACCF may provide a higher fusion rate than multilevel ACDF but also a higher graft failure rate than multilevel ACDF (Class III). Anterior cervical discectomy with fusion, ACCF, laminectomy, laminoplasty, and laminectomy with arthrodesis all provide near-term functional improvement for CSM. However, laminectomy is associated with late deterioration compared with the other types of anterior and posterior surgeries (Class III).
  
  
  CONCLUSIONS
  Multiple approaches exist with similar near-term improvements; however, laminectomy appears to have a late deterioration rate that may need to be considered when appropriate.
authors.affiliation: Department of Neurosurgery, University of California at San Francisco, California, USA.
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.forename: Michael G
authors.initials: MG
authors.lastname: Kaiser
authors.forename: Paul G
authors.initials: PG
authors.lastname: Matz
authors.forename: Paul A
authors.initials: PA
authors.lastname: Anderson
authors.forename: Michael W
authors.initials: MW
authors.lastname: Groff
authors.forename: Robert F
authors.initials: RF
authors.lastname: Heary
authors.forename: Langston T
authors.initials: LT
authors.lastname: Holly
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Ryken
authors.forename: Tanvir F
authors.initials: TF
authors.lastname: Choudhri
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Vresilovic
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Resnick
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods; D013118:Spinal Cord Diseases / Q000601:surgery*; D055009:Spondylosis / Q000601:surgery*