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Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy.
Spine (Phila Pa 1976). 2011 Nov 01; 36(23):1940-7.S

Abstract

STUDY DESIGN

A clinical prospective study.

OBJECTIVE

To assess whether clinical and radiologic outcomes differ between anterior decompression and fusion (ADF) and laminoplasty (LAMP) in the treatment of cervical spondylotic myelopathy (CSM).

SUMMARY OF BACKGROUND DATA

No reports to date have accurately and prospectively compared middle-term clinical outcomes after anterior and posterior decompression for CSM.

METHODS

We prospectively performed LAMP (n = 50) in 1996, 1998, 2000, and 2002, and ADF (n = 45) in 1997, 1999, 2001, and 2003. The Japanese Orthopedic Association (JOA) score, recovery rate, and each item of the JOA score were evaluated. For radiographic evaluation, the lordotic angle and range of motion (ROM) at C2-C7 and residual anterior compression to the spinal cord (ACS) after LAMP on magnetic resonance imaging were investigated.

RESULTS

Eighty-six patients (ADF n = 39; LAMP n = 47) could be followed for more than 5 years (follow-up rate 91.5%). Demographics were similar between the two groups. The mean JOA score and recovery rate in the ADF group were superior to those in the LAMP group from 2-year data collected after surgery. However, LAMP was safer and less invasive than ADF with respect to physical status and complications in the perioperative period. For individual items of the JOA score, the ADF group showed significantly more improvement of upper extremity motor function than the LAMP group (P < 0.05). There was a significant difference in maintenance of the lordotic angle in the ADF group compared with the LAMP group despite no difference in ROM.The LAMP group was divided into two subgroups: (1) LAMP(+) (n = 16) comprising patients who had ACS at 2 years after surgery, and (2) LAMP(-) (n = 31) comprising patients without ACS. Recovery rate differed significantly between the LAMP(+) and LAMP(-) groups despite there being no difference between the LAMP(-) and ADF groups.

CONCLUSION

The recovery rate of the JOA score in the ADF group was better than that in the LAMP group. The clinical outcomes after LAMP could be influenced by ACS.

Authors+Show Affiliations

Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21289554

Citation

Hirai, Takashi, et al. "Middle-term Results of a Prospective Comparative Study of Anterior Decompression With Fusion and Posterior Decompression With Laminoplasty for the Treatment of Cervical Spondylotic Myelopathy." Spine, vol. 36, no. 23, 2011, pp. 1940-7.
Hirai T, Okawa A, Arai Y, et al. Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy. Spine. 2011;36(23):1940-7.
Hirai, T., Okawa, A., Arai, Y., Takahashi, M., Kawabata, S., Kato, T., Enomoto, M., Tomizawa, S., Sakai, K., Torigoe, I., & Shinomiya, K. (2011). Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy. Spine, 36(23), 1940-7. https://doi.org/10.1097/BRS.0b013e3181feeeb2
Hirai T, et al. Middle-term Results of a Prospective Comparative Study of Anterior Decompression With Fusion and Posterior Decompression With Laminoplasty for the Treatment of Cervical Spondylotic Myelopathy. Spine. 2011 Nov 1;36(23):1940-7. PubMed PMID: 21289554.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy. AU - Hirai,Takashi, AU - Okawa,Atsushi, AU - Arai,Yoshiyasu, AU - Takahashi,Makoto, AU - Kawabata,Shigenori, AU - Kato,Tsuyoshi, AU - Enomoto,Mitsuhiro, AU - Tomizawa,Shoji, AU - Sakai,Kenichiro, AU - Torigoe,Ichiro, AU - Shinomiya,Kenichi, PY - 2011/2/4/entrez PY - 2011/2/4/pubmed PY - 2012/6/2/medline SP - 1940 EP - 7 JF - Spine JO - Spine VL - 36 IS - 23 N2 - STUDY DESIGN: A clinical prospective study. OBJECTIVE: To assess whether clinical and radiologic outcomes differ between anterior decompression and fusion (ADF) and laminoplasty (LAMP) in the treatment of cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: No reports to date have accurately and prospectively compared middle-term clinical outcomes after anterior and posterior decompression for CSM. METHODS: We prospectively performed LAMP (n = 50) in 1996, 1998, 2000, and 2002, and ADF (n = 45) in 1997, 1999, 2001, and 2003. The Japanese Orthopedic Association (JOA) score, recovery rate, and each item of the JOA score were evaluated. For radiographic evaluation, the lordotic angle and range of motion (ROM) at C2-C7 and residual anterior compression to the spinal cord (ACS) after LAMP on magnetic resonance imaging were investigated. RESULTS: Eighty-six patients (ADF n = 39; LAMP n = 47) could be followed for more than 5 years (follow-up rate 91.5%). Demographics were similar between the two groups. The mean JOA score and recovery rate in the ADF group were superior to those in the LAMP group from 2-year data collected after surgery. However, LAMP was safer and less invasive than ADF with respect to physical status and complications in the perioperative period. For individual items of the JOA score, the ADF group showed significantly more improvement of upper extremity motor function than the LAMP group (P < 0.05). There was a significant difference in maintenance of the lordotic angle in the ADF group compared with the LAMP group despite no difference in ROM.The LAMP group was divided into two subgroups: (1) LAMP(+) (n = 16) comprising patients who had ACS at 2 years after surgery, and (2) LAMP(-) (n = 31) comprising patients without ACS. Recovery rate differed significantly between the LAMP(+) and LAMP(-) groups despite there being no difference between the LAMP(-) and ADF groups. CONCLUSION: The recovery rate of the JOA score in the ADF group was better than that in the LAMP group. The clinical outcomes after LAMP could be influenced by ACS. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/21289554/Middle_term_results_of_a_prospective_comparative_study_of_anterior_decompression_with_fusion_and_posterior_decompression_with_laminoplasty_for_the_treatment_of_cervical_spondylotic_myelopathy_ L2 - http://dx.doi.org/10.1097/BRS.0b013e3181feeeb2 DB - PRIME DP - Unbound Medicine ER -