title: Effectiveness of 3 surgical decompression strategies for treatment of multilevel cervical myelopathy in 3 spinal centers in China: a retrospective study.
abstract: METHODS
  Retrospective multicenter study.
  
  
  OBJECTIVE
  To compare clinical outcomes and surgical-related adverse events in patients with multilevel cervical myelopathy (MCM) undergoing simple anterior, simple posterior, or 1-stage posterior-anterior surgical decompression strategies.
  
  
  BACKGROUND
  Simple anterior, simple posterior, and 1-stage posterior-anterior surgical decompression strategies have been advocated for MCM treatment in both Western and Chinese populations. However, there is limited evidence on whether 1-stage posterior-anterior strategy may offer equal or more advantages than the other 2 strategies for patients with MCM.
  
  
  METHODS
  A retrospective review of medical records was conducted for 255 patients with MCM who had undergone surgical decompression in 3 Chinese spinal centers from 1999 to 2010. Neurological status, perioperative variables, and surgical complications were assessed. Multiple linear regression was used to evaluate factors associated with the outcomes of each strategy.
  
  
  RESULTS
  Analyses were conducted on a total of 229 patients with MCM undergoing surgical decompression via 1-stage posterior-anterior (68 patients), simple anterior (102 patients), and simple posterior approaches (59 patients). One-stage posterior-anterior approach had the highest Japanese Orthopaedic Association recovery rate after adjusted for age and sex (adjusted mean ± SD: 50.0 ± 3.2, P < 0.001) and additionally adjusted for smoking, duration from onset of symptoms to surgery, comorbidities, preoperative Japanese Orthopaedic Association score, Ishihara's curvature index and Pavlov ratio, operative blood loss, operating time, anterior operated disc levels, and posterior operated levels (adjusted mean ± SD: 51.6 ± 11.6, P < 0.01). Anterior approach had the largest difference between the pre- and postoperative Ishihara's curvature indexes after adjusted for age and sex (adjusted mean ± SD: 5.3 ± 1.0, P < 0.01) and after multivariable adjustment (adjusted mean ± SD: 6.5 ± 2.8, P = 0.003).
  
  
  CONCLUSIONS
  One-stage posterior-anterior strategy can be a reliable and effective treatment strategy for MCM in a subgroup of patients with anterior and posterior compression on spinal cord simultaneously.
authors: Department of Spine Surgery, The First Municipal People's Hospital of Guangzhou, Affiliated Hospital to The Guangzhou Medical University, People's Republic of China.
authors: Shi-Feng
authors: SF
authors: Wen
authors: Irene Oi-Ling
authors: IO
authors: Wong
authors: Mei-Jing
authors: MJ
authors: Long
authors: Ju-Geng
authors: JG
authors: Li
authors: Xiao-Feng
authors: XF
authors: Li
authors: Dong-Ming
authors: DM
authors: Guo
authors: Zhong-He
authors: ZH
authors: Xu
authors: Qing-Shui
authors: QS
authors: Yin
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology; D044466:Asian People; D002574:Cervical Vertebrae; D002681:China; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013117:Spinal Cord Compression / Q000208:ethnology / Q000503:physiopathology / Q000601:surgery; D013118:Spinal Cord Diseases / Q000208:ethnology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome