title: Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty.
abstract: BACKGROUND
  Multilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach.
  
  
  OBJECTIVE
  To elucidate any potential advantage of one approach over the other with regard to clinical midterm outcomes in this study.
  
  
  METHODS
  A prospective, 2-year follow-up of patients with cervical myelopathy treated with multilevel anterior cervical decompression fusion and plating and posterior laminoplasty.
  
  
  METHODS
  In total, 116 patients were studied. Sixty-four patients underwent ACDF two levels and above or anterior cervical corpectomy and fusion one level and above. Fifty-two patients underwent posterior cervical surgery (laminoplasty C3-C6 and C3-C7).
  
  
  METHODS
  Self-report measures: Japan Orthopedic Association (JOA) score, JOA recovery rate, visual analog scale for neck pain (VASNP), neck disability index (NDI), and American Academy of Orthopaedic Surgeons (AAOS) neurogenic symptom score (AAOS-NSS). Physiologic measures: range of motion (ROM) flexion and extension of neck. Functional measures: short-form 36 (SF-36) score comprising physical functioning, physical role function, bodily pain, general health, vitality, social role function, emotional role function, and mental health scales.
  
  
  METHODS
  Comparison of the JOA scores, JOA recovery rates, NDI scores, SF-36 scores, VASNP, and ROM preoperatively to 2 years. Chi-square and two-sided Student t tests were used to analyze the variables.
  
  
  RESULTS
  Posterior surgery took an hour shorter (p<.05) and had better improvement in JOA scores at early follow-up of 6 months (p=.025). Anterior surgery group had better improvement of NDI scores at early follow-up of 6 months (p=.024) and was associated with less blood loss intraoperatively compared with posterior surgery. There was no statistical difference between the two groups for JOA scores, JOA recovery rates, SF-36 quality-of-life scores, NDI, AAOS-NSS, VAS neck pain, and ROM at 2 years. Complications were higher for anterior surgery group: two hematoma postoperation, one vocal cord paresis, and one new onset C6/C7 dermatome numbness versus one dura leak in posterior surgery group.
  
  
  CONCLUSIONS
  Our study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy.
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Rd, Singapore 169608, Singapore.
authors.forename: Chusheng
authors.initials: C
authors.lastname: Seng
authors.forename: Benjamin P B
authors.initials: BP
authors.lastname: Tow
authors.forename: Mashfiqul A
authors.initials: MA
authors.lastname: Siddiqui
authors.forename: Abhishek
authors.initials: A
authors.lastname: Srivastava
authors.forename: Lushun
authors.initials: L
authors.lastname: Wang
authors.forename: Andy K S
authors.initials: AK
authors.lastname: Yew
authors.forename: William
authors.initials: W
authors.lastname: Yeo
authors.forename: Shu Hui Rebecca
authors.initials: SH
authors.lastname: Khoo
authors.forename: Nidu Maran Shanmugam
authors.initials: NM
authors.lastname: Balakrishnan
authors.forename: Hamid Rahmatullah
authors.initials: HR
authors.lastname: Bin Abd Razak
authors.forename: John L T
authors.initials: JL
authors.lastname: Chen
authors.forename: Chang M
authors.initials: CM
authors.lastname: Guo
authors.forename: Seang B
authors.initials: SB
authors.lastname: Tan
authors.forename: Wai-Mun
authors.initials: WM
authors.lastname: Yue
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007564:Japan; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular; D013118:Spinal Cord Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Anterior cervical decompression; Cervical myelopathy; Functional outcome; Laminoplasty