title: Comparison between anterior and posterior decompression for cervical spondylotic myelopathy: subjective evaluation and cost analysis.
abstract: OBJECTIVE
  To compare anterior and posterior approaches for treating cervical spondylotic myelopathy (CSM) involving more than two levels, especially in regard to quality of life and cost effectiveness.
  
  
  METHODS
  The authors studied 116 CSM patients who underwent decompressive surgery by either an anterior or a posterior approach with instrumentation. In the anterior group, 1-3 levels subtotal vertebrectomy was followed by bone graft and Orion anterior cervical locking plate fixation. In the posterior group, multilevel laminectomy with posterior screw-rod fixation was performed. Follow-up, which included radiographic assessment, clinical examination and documentation of length of any hospitalization and cost and incidence of complications, was performed 1 day before discharge, 6 months after leaving hospital, and at final follow-up.
  
  
  RESULTS
  Both groups had improved clinical outcomes. The anterior group showed greater satisfaction but lower visual analog scale scores than the posterior group, whereas SF-36 emotional role and mental health scores were higher in the anterior group. There was no marked difference between the two groups in length of hospitalization and most of the costs of treating CSM, however treatment and examination fees were significantly higher in the posterior group.
  
  
  CONCLUSIONS
  Both anterior and posterior decompressions (with instrumentation) are effective procedures for improving the neurological outcomes of patients with CSM. However, although the two approaches have similar health care costs, anterior cervical corpectomy (with instrumentation) seems to be subjectively assessed by patients as better.
authors.affiliation: Department of Orthopaedics, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
authors.forename: Wei
authors.initials: W
authors.lastname: Ma
authors.forename: Feng
authors.initials: F
authors.lastname: Zhu
authors.forename: Chi-hua
authors.initials: CH
authors.lastname: Guo
authors.forename: Wen-long
authors.initials: WL
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000601:surgery*; D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000191:economics / Q000379:methods* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007796:Laminectomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D020127:Recovery of Function; D013117:Spinal Cord Compression / Q000191:economics / Q000523:psychology / Q000601:surgery*; D055009:Spondylosis / Q000191:economics / Q000523:psychology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome