title: Anterior approaches for cervical spondylotic myelopathy: which? When? How?
abstract: Cervical spondylotic myelopathy is a degenerative disorder with an unfavorable natural history. Surgical treatment options have evolved substantially over time, with both anterior and posterior methods proving successful for certain patients with specific characteristics. Anterior decompression of the spinal canal plus fusion techniques for stabilization has several advantages and some disadvantages when compared to posterior options. Understanding the pros and cons of the approaches and techniques is critical for the surgeon to select the best operative treatment strategy for any given patient to achieve the best outcome. Multiple decision-making factors are involved, such as sagittal alignment, number of levels, shape of the pathoanatomy, age and comorbidities, instability, and pre-operative pain levels. Any or all of these factors may be relevant for a given patient, and to varying degrees of importance. Choice of operative approach will therefore be dependent on patient presentation, risks of that approach for a given patient, and to some degree surgeon experience.
authors: Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV, 26506-9196, USA, semery@hsc.wvu.edu.
authors: Sanford E
authors: SE
authors: Emery
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D013118:Spinal Cord Diseases / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D055009:Spondylosis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
references: J Neurosurg Spine. 2009 May;10(5):458-65
references: 19442008
references: Spine (Phila Pa 1976). 2009 Dec 15;34(26):2874-9
references: 19949366
references: J Spinal Disord Tech. 2009 Feb;22(1):14-20
references: 19190429
references: Neurosurgery. 1999 Dec;45(6):1481-5; discussion 1485-6
references: 10598719
references: Spine (Phila Pa 1976). 2012 Mar 15;37(6):445-51
references: 21587111
references: Spine (Phila Pa 1976). 2012 Sep 1;37(19):1645-51
references: 22433506
references: J Spinal Disord Tech. 2009 Oct;22(7):511-5
references: 20075815
references: Spine (Phila Pa 1976). 2011 Jan 1;36(1):15-20
references: 20562731
references: Spine (Phila Pa 1976). 2013 Jun 15;38(14):1170-6
references: 23462574
references: Spine (Phila Pa 1976). 2009 Feb 1;34(3):229-32
references: 19148042
references: Spine (Phila Pa 1976). 2010 Jul 15;35(16):E782-6
references: 20581755
references: Spine (Phila Pa 1976). 2009 Apr 1;34(7):641-6
references: 19287352
references: Spine (Phila Pa 1976). 2002 Nov 15;27(22):2453-8
references: 12435974
references: J Neurosurg. 2002 Jan;96(1 Suppl):10-6
references: 11795694
references: Spine (Phila Pa 1976). 2006 Aug 1;31(17 ):1911-5
references: 16924207
references: Spine (Phila Pa 1976). 2003 Jan 15;28(2):140-2
references: 12544930
references: Spine (Phila Pa 1976). 2012 Nov 1;37(23 ):E1450-8
references: 22869063
references: J Neurosurg Spine. 2012 May;16(5):425-32
references: 22324802
references: Eur Spine J. 2009 May;18(5):654-62
references: 19214597
references: Eur Spine J. 2012 Dec;21(12):2428-35
references: 22644433
references: Spine (Phila Pa 1976). 2000 Aug 15;25(16):2040-4; discussion 2045-6
references: 10954634
references: Neurosurgery. 2011 Mar;68(3):622-30; discussion 630-1
references: 21164373
references: Spine (Phila Pa 1976). 1996 Sep 1;21(17):1969-73
references: 8883196
references: Spine (Phila Pa 1976). 2001 Jun 15;26(12):1324-9
references: 11426146
references: Spine (Phila Pa 1976). 2012 Sep 15;37(20):E1260-3
references: 22744617
references: Spine (Phila Pa 1976). 2002 Jun 1;27(11):1168-75
references: 12045513
references: Spine (Phila Pa 1976). 1994 Mar 1;19(5):507-10
references: 8184342
references: Spine (Phila Pa 1976). 2001 Jul 1;26(13):1443-7; discussion 1448
references: 11458148
references: J Bone Joint Surg Am. 2009 Oct 1;91 Suppl 2:223-32
references: 19805586
references: Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S210-31
references: 24113359
references: J Bone Joint Surg Am. 1998 Jul;80(7):941-51
references: 9697998
references: Spine (Phila Pa 1976). 2005 Sep 1;30(17):1963-9
references: 16135986
references: Spine (Phila Pa 1976). 2013 Dec 15;38(26):2247-52
references: 24108289
references: Eur Spine J. 2010 Oct;19(10):1702-10
references: 20461418
references: Eur Spine J. 2012 Mar;21(3):474-81
references: 21826497
references: Neurosurgery. 2007 Sep;61(3 Suppl):106-12; discussion 112
references: 17876240
references: Spine (Phila Pa 1976). 2001 Mar 15;26(6):643-6; discussion 646-7
references: 11246376
references: Spine J. 2009 Feb;9(2):121-7
references: 18261963
references: Spine (Phila Pa 1976). 2005 Nov 15;30(22):2564-9
references: 16284596
references: Spine (Phila Pa 1976). 2011 Nov 1;36(23 ):1940-7
references: 21289554
references: Clin Orthop Relat Res. 2011 Mar;469(3):666-73
references: 20882376
references: Spine J. 2003 Nov-Dec;3(6):451-9
references: 14609689
references: J Bone Joint Surg Am. 1999 Apr;81(4):519-28
references: 10225797
references: Spine (Phila Pa 1976). 2002 Jan 15;27(2):146-51
references: 11805659
references: Spine (Phila Pa 1976). 2009 Jul 1;34(15):1567-71
references: 19564766
references: J Neurosurg Spine. 2009 Nov;11(5):518-9; discussion 519-20
references: 19929352
references: Spine (Phila Pa 1976). 2008 Apr 1;33(7):771-8
references: 18379404
references: J Neurosurg Spine. 2009 Aug;11(2):130-41
references: 19769492
references: Spine (Phila Pa 1976). 2007 Mar 15;32(6):654-60
references: 17413470
references: J Spinal Disord Tech. 2010 Jul;23 (5):310-6
references: 20124907
references: Spine J. 2007 Nov-Dec;7(6):633-6
references: 17998121
references: Spine (Phila Pa 1976). 2013 Jul 15;38(16):1409-21
references: 23591658
references: Eur Spine J. 2011 Sep;20(9):1539-44
references: 21448583
references: J Neurosurg Spine. 2009 Nov;11(5):521-8
references: 19929353
references: Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S195-209
references: 23962998
references: Neurosurgery. 1999 Jan;44(1):81-90
references: 9894967
references: J Spinal Disord. 1998 Oct;11(5):410-5
references: 9811102
references: Eur Spine J. 2011 Feb;20(2):224-35
references: 20582710
references: Spine (Phila Pa 1976). 2010 Mar 1;35(5):537-43
references: 20190625
references: J Neurosurg Spine. 2007 Apr;6(4):298-303
references: 17436916
references: Eur Spine J. 2013 Jul;22(7):1583-93
references: 23657624
references: Spine J. 2007 Mar-Apr;7(2):141-7
references: 17321961
references: J Neurosurg Spine. 2011 May;14(5):619-25
references: 21388285