Background Though both anterior and posterior approach are used for the management of multilevel cervical spondylotic myelopathy (CSM), the choice between both approaches remains to be of considerable debate. Aim of the work The aim of the study was to evaluate the clinical and radiographic outcomes of patients with multiple level CSM who underwent posterior laminectomy (PL) versus anterior cervical discectomy and fusion (ACDF). Methods This is a retrospective comparative study of 30 patients, with multiple level CSM managed by the authors, either by PL ( n = 15) or ACDF ( n = 15). Clinical outcome was assessed at 1, 3, 6, and 12 months postoperatively using the modified Japanese Orthopedic Association scale (mJOA) while the postoperative radiographic changes represented by the Cobb’s angle variation was recorded at 12 months postoperatively and compared with preoperative values. Also, the incidence of postoperative complications and neurological deterioration was recorded and studied between the two groups. Study duration was for 2 years from December 2014 to December 2016. Results Both the ACDF and PL groups showed an improvement in the mJOA score mean value at 1 year after surgery in comparison with the preoperative evaluation data; however, on comparing between both groups at 1 year postoperatively, the median percent of increase in mJOA score was significantly higher in the ACDF group compared with the PL group (33.3% vs 22.2% respectively). On the other hand, the Cobb’s angle percent of change 1 year after surgery showed a median percent of increase of 18.7% in the ACDF group in contrast to a median decrease of − 11.1% in the PL group which was statistically significant. Minimal complications were reported in both groups. Conclusion Both PL and ACDF are effective modalities for the surgical management of multilevel CSM showing good clinical outcome; however, when compared with the posterior approach, there was a statistical significant difference favoring ACDF regarding the median percent of increase in mJOA score and the postoperative Cobb’s angle improvement.

中文翻译：

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多节段前路颈椎间盘切除融合术与后路椎板切除术治疗多节段脊髓型颈椎病的临床和放射学结果

背景 尽管前路和后路均用于治疗多节段脊髓型颈椎病 (CSM)，但两种入路之间的选择仍有相当大的争议。工作目的 本研究的目的是评估接受后路椎板切除术 (PL) 与前路颈椎间盘切除融合术 (ACDF) 的多节段 CSM 患者的临床和影像学结果。方法 这是一项对 30 名患者的回顾性比较研究，由作者管理的多级 CSM，由 PL (n = 15) 或 ACDF (n = 15) 管理。临床结果在 1、3、6、术后 12 个月使用改良的日本骨科协会量表 (mJOA) 记录术后 12 个月以 Cobb 角变化为代表的术后影像学变化，并与术前值进行比较。此外，记录和研究两组术后并发症和神经功能恶化的发生率。研究时间为2014年12月至2016年12月2年。结果ACDF组和PL组术后1年mJOA评分均值较术前评估数据均有改善；然而，在术后 1 年对两组进行比较时，ACDF 组的 mJOA 评分增加的中位数百分比显着高于 PL 组（分别为 33.3% 和 22.2%）。另一方面，术后 1 年 Cobb 角变化百分比显示，ACDF 组中位增加 18.7%，而 PL 组中位减少 - 11.1%，具有统计学意义。两组都报告了最小的并发症。结论 PL和ACDF均是多节段CSM手术治疗的有效方法，临床效果良好；然而，与后路入路相比，在 mJOA 评分增加的中位数百分比和术后 Cobb 角改善方面，有利于 ACDF 的统计学显着差异。两组都报告了最小的并发症。结论 PL和ACDF均是多节段CSM手术治疗的有效方法，临床效果良好；然而，与后路入路相比，在 mJOA 评分增加的中位数百分比和术后 Cobb 角改善方面，有利于 ACDF 的统计学显着差异。两组都报告了最小的并发症。结论 PL和ACDF均是多节段CSM手术治疗的有效方法，临床效果良好；然而，与后路入路相比，在 mJOA 评分增加的中位数百分比和术后 Cobb 角改善方面，有利于 ACDF 的统计学显着差异。