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Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty.
Spine J. 2013 Jul; 13(7):723-31.SJ

Abstract

BACKGROUND CONTEXT

Multilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach.

PURPOSE

To elucidate any potential advantage of one approach over the other with regard to clinical midterm outcomes in this study.

STUDY DESIGN

A prospective, 2-year follow-up of patients with cervical myelopathy treated with multilevel anterior cervical decompression fusion and plating and posterior laminoplasty.

PATIENT SAMPLE

In total, 116 patients were studied. Sixty-four patients underwent ACDF two levels and above or anterior cervical corpectomy and fusion one level and above. Fifty-two patients underwent posterior cervical surgery (laminoplasty C3-C6 and C3-C7).

OUTCOME MEASURES

Self-report measures: Japan Orthopedic Association (JOA) score, JOA recovery rate, visual analog scale for neck pain (VASNP), neck disability index (NDI), and American Academy of Orthopaedic Surgeons (AAOS) neurogenic symptom score (AAOS-NSS). Physiologic measures: range of motion (ROM) flexion and extension of neck. Functional measures: short-form 36 (SF-36) score comprising physical functioning, physical role function, bodily pain, general health, vitality, social role function, emotional role function, and mental health scales.

METHODS

Comparison of the JOA scores, JOA recovery rates, NDI scores, SF-36 scores, VASNP, and ROM preoperatively to 2 years. Chi-square and two-sided Student t tests were used to analyze the variables.

RESULTS

Posterior surgery took an hour shorter (p<.05) and had better improvement in JOA scores at early follow-up of 6 months (p=.025). Anterior surgery group had better improvement of NDI scores at early follow-up of 6 months (p=.024) and was associated with less blood loss intraoperatively compared with posterior surgery. There was no statistical difference between the two groups for JOA scores, JOA recovery rates, SF-36 quality-of-life scores, NDI, AAOS-NSS, VAS neck pain, and ROM at 2 years. Complications were higher for anterior surgery group: two hematoma postoperation, one vocal cord paresis, and one new onset C6/C7 dermatome numbness versus one dura leak in posterior surgery group.

CONCLUSIONS

Our study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Rd, Singapore 169608, Singapore.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 availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23541452

Citation

Seng, Chusheng, et al. "Surgically Treated Cervical Myelopathy: a Functional Outcome Comparison Study Between Multilevel Anterior Cervical Decompression Fusion With Instrumentation and Posterior Laminoplasty." The Spine Journal : Official Journal of the North American Spine Society, vol. 13, no. 7, 2013, pp. 723-31.
Seng C, Tow BP, Siddiqui MA, et al. Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. Spine J. 2013;13(7):723-31.
Seng, C., Tow, B. P., Siddiqui, M. A., Srivastava, A., Wang, L., Yew, A. K., Yeo, W., Khoo, S. H., Balakrishnan, N. M., Bin Abd Razak, H. R., Chen, J. L., Guo, C. M., Tan, S. B., & Yue, W. M. (2013). Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. The Spine Journal : Official Journal of the North American Spine Society, 13(7), 723-31. https://doi.org/10.1016/j.spinee.2013.02.038
Seng C, et al. Surgically Treated Cervical Myelopathy: a Functional Outcome Comparison Study Between Multilevel Anterior Cervical Decompression Fusion With Instrumentation and Posterior Laminoplasty. Spine J. 2013;13(7):723-31. PubMed PMID: 23541452.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. AU - Seng,Chusheng, AU - Tow,Benjamin P B, AU - Siddiqui,Mashfiqul A, AU - Srivastava,Abhishek, AU - Wang,Lushun, AU - Yew,Andy K S, AU - Yeo,William, AU - Khoo,Shu Hui Rebecca, AU - Balakrishnan,Nidu Maran Shanmugam, AU - Bin Abd Razak,Hamid Rahmatullah, AU - Chen,John L T, AU - Guo,Chang M, AU - Tan,Seang B, AU - Yue,Wai-Mun, Y1 - 2013/03/27/ PY - 2011/10/01/received PY - 2012/11/25/revised PY - 2013/02/18/accepted PY - 2013/4/2/entrez PY - 2013/4/2/pubmed PY - 2014/2/18/medline KW - Anterior cervical decompression KW - Cervical myelopathy KW - Functional outcome KW - Laminoplasty SP - 723 EP - 31 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 13 IS - 7 N2 - BACKGROUND CONTEXT: Multilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach. PURPOSE: To elucidate any potential advantage of one approach over the other with regard to clinical midterm outcomes in this study. STUDY DESIGN: A prospective, 2-year follow-up of patients with cervical myelopathy treated with multilevel anterior cervical decompression fusion and plating and posterior laminoplasty. PATIENT SAMPLE: In total, 116 patients were studied. Sixty-four patients underwent ACDF two levels and above or anterior cervical corpectomy and fusion one level and above. Fifty-two patients underwent posterior cervical surgery (laminoplasty C3-C6 and C3-C7). OUTCOME MEASURES: Self-report measures: Japan Orthopedic Association (JOA) score, JOA recovery rate, visual analog scale for neck pain (VASNP), neck disability index (NDI), and American Academy of Orthopaedic Surgeons (AAOS) neurogenic symptom score (AAOS-NSS). Physiologic measures: range of motion (ROM) flexion and extension of neck. Functional measures: short-form 36 (SF-36) score comprising physical functioning, physical role function, bodily pain, general health, vitality, social role function, emotional role function, and mental health scales. METHODS: Comparison of the JOA scores, JOA recovery rates, NDI scores, SF-36 scores, VASNP, and ROM preoperatively to 2 years. Chi-square and two-sided Student t tests were used to analyze the variables. RESULTS: Posterior surgery took an hour shorter (p<.05) and had better improvement in JOA scores at early follow-up of 6 months (p=.025). Anterior surgery group had better improvement of NDI scores at early follow-up of 6 months (p=.024) and was associated with less blood loss intraoperatively compared with posterior surgery. There was no statistical difference between the two groups for JOA scores, JOA recovery rates, SF-36 quality-of-life scores, NDI, AAOS-NSS, VAS neck pain, and ROM at 2 years. Complications were higher for anterior surgery group: two hematoma postoperation, one vocal cord paresis, and one new onset C6/C7 dermatome numbness versus one dura leak in posterior surgery group. CONCLUSIONS: Our study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/23541452/Surgically_treated_cervical_myelopathy:_a_functional_outcome_comparison_study_between_multilevel_anterior_cervical_decompression_fusion_with_instrumentation_and_posterior_laminoplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(13)00238-6 DB - PRIME DP - Unbound Medicine ER -