title: A Comparative Study of Anterior Decompression With Fusion and Posterior Decompression With Laminoplasty for the Treatment of Cervical Spondylotic Myelopathy Patients With Large Anterior Compression of the Spinal Cord.
abstract: METHODS
  This is a retrospective observational single-center study.
  
  
  OBJECTIVE
  To compare anterior decompression and fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM) patients with large anterior compression in terms of clinical and radiologic outcomes.
  
  
  BACKGROUND
  We have reported that insufficient posterior decompression could be often seen after laminoplasty for CSM patients with preoperative anterior clearance of the spinal cord, defined as an interval <4 mm between the preoperative the modified K-line and anterior structure of the spinal canal at most compressive segment on sagittal T1-weighted magnetic resonance imaging. Here we conduct a study comparing ADF and LAMP for the treatment of CSM patients with such a risk factor.
  
  
  METHODS
  Of the 221 consecutive CSM patients treated with either ADF or LAMP between 2008 and 2012 at our hospital, 79 patients in whom the interval was <4 mm with age ranged from 50 to 79 years were enrolled. Patients with myelopathy caused by single-level disk herniation, tumor or ossification of posterior longitudinal ligament, or patients with a history of cervical spine injury were excluded. The Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy, recovery rate of the JOA score at the time of 2 years after surgery were investigated as clinical outcomes to compare these 2 groups.
  
  
  RESULTS
  Demographics were almost similar between ADF and LAMP groups. The mean preoperative and postoperative JOA scores were 10.9 and 13.8 points for ADF group and 10.1 and 12.4 points for LAMP group, indicating that the recovery rate of JOA score was significantly greater in ADF group (49.6%) than that in LAMP group (38.2%; P=0.047). In LAMP group, spinal cord deformity was a significant predictive factor for unsatisfactory clinical outcome.
  
  
  CONCLUSIONS
  ADF provided better surgical treatment for the patients with absence of preoperative anterior clearance of the spinal cord.
authors.affiliation: *Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama †Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hirai
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Yoshii
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Arai
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Sakai
authors.forename: Ichiro
authors.initials: I
authors.lastname: Torigoe
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Maehara
authors.forename: Masaki
authors.initials: M
authors.lastname: Tomori
authors.forename: Takashi
authors.initials: T
authors.lastname: Taniyama
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sato
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okawa
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical; D003710:Demography; D005260:Female; D006801:Humans; D065406:Laminoplasty; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012307:Risk Factors; D013117:Spinal Cord Compression / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D055009:Spondylosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome