Anterior cervical discectomy and fusion with and without plating versus laminectomy with and without fusion for multilevel cervical spondylotic myelopathy: a prospective observational study

Abstract

Cervical spondylotic myelopathy (CSM) is a chronic progressive spinal compression that usually accompanies age-related degeneration of the cervical spine and represents one of the most common causes of spinal cord dysfunction. Surgical intervention is the foundation of management in symptomatic cases, but the approach of choice is constantly contentious. The aim of this study is to evaluate and appraise different surgical approaches for multilevel cervical spondylotic myelopathy (anterior cervical discectomy and fusion (ACDF) with or without plating and laminectomy with and without fusion) regarding the perioperative data, clinical outcomes, complications rates and radiographic parameters. In this prospective study, sixty patients in four matched cohorts were followed up. The first group (n = 15) underwent ACDF only, the second group (n = 15) underwent ACDF with anterior plate, the third group (n = 15) underwent laminectomy alone, and the fourth group (n = 15) underwent laminectomy with lateral mass fusion. Patients were followed up for twelve-month duration using modified Japanese orthopedic score (mJOA), neck disability index (NDI), visual analogue scale (VAS) and short form 36 (SF-36) in addition to measurement of C2-C7 cobb`s angle to evaluate postoperative cervical sagittal alignment. All the four groups were associated with functional clinical improvement with no statistically significant differences between them. Postoperative cervical lordosis and its change were highest in anterior groups, both plated (11.1 ± 5.2a, 5.1 ± 4.0a) and non-plated (12.0 ± 5.3a, 4.4 ± 3.2a) (p value < 0.001) with no significant difference between them. Postoperative quality of life score and its change were significantly better in plated anterior approach (55.8 ± 4.8a, 21.6 ± 4.9a) and in non-plated (55.6 ± 3.2a, 21.3 ± 4.0a) (p value < 0.001) with no significant difference between both techniques. Operative time was statistically higher in plated anterior approach (202.1 ± 55.9b) and in laminectomy with fusion (229.2 ± 92.9b) (p value < 0.001) with no statistically significant difference between either group. Posterior approaches were associated with significantly higher intraoperative blood loss (280.0 ± 52.3b for laminectomy and 310.0 ± 60.3b for laminectomy with fusion) (p value < 0.001) with no difference between both techniques. Hospital stay was higher in posterior groups as well, but it was not statistically significant (p value = 0.127). Both anterior and posterior approaches were associated with significant functional improvements with no difference in complications severity or frequency. Anterior surgery had shorter hospital stay and less blood loss with better quality of life scores and more successful restoration of cervical lordosis.