Anterior Versus Posterior Surgical Approaches to Treat Cervical Spondylotic Myelopathy: Outcomes of the Prospective Multicenter AOSpine North America CSM Study in 278 Patients

Fehlings, Michael G.; Kopjar, Branko; Yoon, S. Tim; Arnold, Paul M.; Vaccaro, Alexander R.; Shaffrey, Christopher I.; Brodke, Darrel S.; Woodard, Eric J.; Banco, Robert; Janssen, Michael; Dekutoski, Mark B.; Gokaslan, Ziya L.; Bono, Christopher M.; Massicotte, Eric M.

doi:10.1016/j.spinee.2012.08.026

Cited by 75 publications

(134 citation statements)

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“…Previous investigations into different cervical techniques fail to show superiority of a specific superior approach 8 and a recent publication from a large, prospective multicenter study validated the relative equivalence between anterior and posterior treatment for CSM that many spine surgeons think exists. 5,9 This study, as well as several previous lesser quality series, demonstrate that when the choice of anterior and posterior surgery is decided by the surgeon, patients experience significant, and similar improvements with regard to neurological, functional, and quality-of-life outcomes with comparable and very low rates of neurological complication. 9 Despite extensive investigation of the middle and longterm neurological and clinical outcomes of this common surgical indication, minimal efforts have been made to quantify the risk of surgical outcomes based on surgical approach and technique.…”

Section: Introductionsupporting

confidence: 58%

Perioperative Risks Associated with Cervical Spondylotic Myelopathy Based on Surgical Treatment Strategies

et al. 2015

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BackgroundFew studies have provided nationwide estimates of patient characteristics and procedure-related complications, or examined postsurgical outcomes for patients with cervical spondylotic myelopathy (CSM) comparatively with respect to surgical approach. The objective of this study is to identify patients at risk for morbidity and mortality directly related with the selected approach, report an overall nation-wide complication rate for each approach against which surgeons can compare themselves, and direct future research to improve patient outcomes.

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Section: Introductionsupporting

confidence: 58%

Perioperative Risks Associated with Cervical Spondylotic Myelopathy Based on Surgical Treatment Strategies

et al. 2015

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“…These studies were designed to compare the efficacy and complication rates between 2 different surgical interventions or varying techniques. Studies reported on differences between anterior and posterior approaches (n = 9); 15,18,19,22,30,42,44,48,59 laminoplasty and laminectomy and fusion (n = 4); 10,19,70,72 anterior decompression and Bryan disc (n = 1); 11 and anterior cervical discectomy and fusion (ACDF) and corpectomy (n = 2). 47,63 In addition, 11 studies compared laminoplasty techniques or considered technical differences such as laminoplasty with and without foraminotomy or muscle preservation.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…18,19 The patient demographics were significantly different in the 2 cohorts: patients treated anteriorly were on average younger, their condition was less severe, they had fewer operated levels, and experienced a smaller volume of blood loss than those treated posteriorly. There were, however, no significant differences in rates of major and/or minor complications (p = 0.11 19 22 In addition, there were no significant differences in rates of overall (p = 0.654), surgical (p = 0.507), medical (p = 1.00), or irreversible complications (p = 0.74) between corpectomy and laminectomy and fusion surgeries.…”

Section: Anterior Versus Posteriormentioning

confidence: 99%

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Tetreault

Ibrahim

Côté

et al. 2016

SPI

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OBJECT Although generally safe and effective, surgery for the treatment of cervical spondylotic myelopathy (CSM) is associated with complications in 11%–38% of patients. Several predictors of postoperative complications have been proposed but few are used to detect high-risk patients. A standard approach to identifying “at-risk” patients would improve surgeons’ ability to prevent and manage these complications. The authors aimed to compare the complication rates between various surgical procedures used to treat CSM and to identify patient-specific, clinical, imaging, and surgical predictors of complications. METHODS The authors conducted a systematic review of the literature and searched MEDLINE, MEDLINE in Process, EMBASE, and Cochrane Central Register of Controlled Trials from 1948 to September 2013. Cohort studies designed to evaluate predictors of complications and intervention studies conducted to compare different surgical approaches were included. Each article was critically appraised independently by 2 reviewers, and the evidence was synthesized according to the principles outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS A total of 5472 citations were retrieved. Of those, 60 studies met the inclusion criteria and were included in the review. These studies included 36 prognostic cohort studies and 28 comparative intervention studies. High evidence suggests that older patients are at a greater risk of perioperative complications. Based on low evidence, other clinical factors such as body mass index, smoking status, duration of symptoms, and baseline severity score, are not predictive of complications. With respect to surgical factors, low to moderate evidence suggests that estimated blood loss, surgical approach, and number of levels do not affect rates of complications. A longer operative duration (moderate evidence), however, is predictive of perioperative complications and a 2-stage surgery is related to an increased risk of major complications (high evidence). In terms of surgical techniques, higher rates of neck pain were found in patients undergoing laminoplasty compared with anterior spinal fusion (moderate evidence). In addition, with respect to laminoplasty techniques, there was a lower incidence of C-5 palsy in laminoplasty with concurrent foraminotomy compared with nonforaminotomy (low evidence). CONCLUSIONS The current review suggests that older patients are at a higher risk of perioperative complications. A longer operative duration and a 2-stage surgery both reflect increased case complexity and can indirectly predict perioperative complications.

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“…A recent large prospective observational multicenter study of 280 patients sought to address the issue of anterior versus posterior surgery [13]. At 12-month follow-up, patients with CSM showed significant improvements in both disease-specific and general health-related outcome measures with either anterior or posterior surgery (mJOA, Nurick scale, NDI, and SF-36).…”

Section: Surgical Techniquesmentioning

confidence: 99%

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

Lebl¹,

Hughes²,

Cammisa³

et al. 2011

HSS Jrnl

126

111

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Anterior Versus Posterior Surgical Approaches to Treat Cervical Spondylotic Myelopathy: Outcomes of the Prospective Multicenter AOSpine North America CSM Study in 278 Patients

Cited by 75 publications

References 0 publications

Perioperative Risks Associated with Cervical Spondylotic Myelopathy Based on Surgical Treatment Strategies

Perioperative Risks Associated with Cervical Spondylotic Myelopathy Based on Surgical Treatment Strategies

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

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