Comparison of Anterior and Posterior Surgery for Degenerative Cervical Myelopathy

Kato, So; Nouri, Aria; Wu, Dongjin; Nori, Satoshi; Tetreault, Lindsay; Fehlings, Michael G.

doi:10.2106/jbjs.16.00882

Cited by 81 publications

(41 citation statements)

References 37 publications

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“…Surgical complications of CM include dysphagia, airway compromise, dysphonia, C5 nerve palsy, blood loss, and postoperative wound infection. For all CM patients (regardless of T2-weighted imaging findings), no significant differences in complication rates and revision rates have been observed in previous studies when comparing the anterior approach with the posterior approach [41–43]. Data for patients with ISI on T2-weighted MRI are scarce, and the available studies did not report the incidence rate in detail.…”

Section: Discussionmentioning

confidence: 94%

Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis

Chen

Wang

et al. 2019

J Orthop Surg Res

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Objective Increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) often indicates severe compression in patients with cervical myelopathy (CM). The optimal surgical approach for CM patients with ISI on T2-weighted MRI remains unclear. This meta-analysis aims to compare the clinical outcomes between anterior and posterior approaches for the treatment of these patients. Methods MEDLINE, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) were searched for relevant studies through January 2019. Statistical comparisons were made when appropriate. Results A total of 9 studies (748 participants) out of 1066 citations were included in this study. All of the selected studies were high quality, as indicated by the Newcastle–Ottawa scale and the Cochrane Collaboration tool for assessing the risk of bias. Clinical outcomes were compared between anterior and posterior approaches in 4 studies (237 participants). The preoperative Japanese Orthopedic Association (JOA) score was similar between the two groups [ P = 0.98, weighted mean difference (WMD) = 0.01 (− 0.58, 0.59)]. The postoperative JOA score [ P < 0.05, WMD = 0.68 (0.06, 1.30)] and recovery rates [ P < 0.01, WMD = 0.12 (0.06, 0.17)] were significantly higher in the anterior group than in the posterior group. Conclusion The anterior approach was associated with better postoperative neural function than the posterior approach in CM patients with ISI on T2-weighted MRI.

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Section: Discussionmentioning

confidence: 94%

Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis

Chen

Wang

et al. 2019

J Orthop Surg Res

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“…A recent propensity-score matched study on inpatient complications on 13,884 (n = 6942 ACDF [Anterior Cervical Decompression and Fusion]; n = 6942 PCDF [Posterior Cervical Decompression and Fusion]) patients demonstrated PCDF to be associated with greater length of stay, in-hospital costs, and general medical and surgical complications, while ACDF carried higher risk of postoperative hematoma, hoarseness, and dysphagia [41]. However, an MRI-based propensity-score-matched analysis comparing anterior vs. posterior surgery showed no significant differences in neurological outcome [42]. It is anticipated that a randomized multicenter prospective study (CSM-S trial, identifier: NCT02076113) will provide some final clarity on a subject matter that has predominated the DCM literature over the last decade [43].…”

Section: Debate: Anterior Vs Posterior Surgical Approachmentioning

confidence: 99%

Degenerative Cervical Myelopathy: A Brief Review of Past Perspectives, Present Developments, and Future Directions

Nouri

Cheng

Davies

et al. 2020

JCM

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Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord injury in developed countries; its prevalence is increasing due to the ageing of the population. DCM causes neurological dysfunction and is a significant cause of disability in the elderly. It has important negative impacts on the quality of life of those affected, as well as on their caregivers. DCM is triggered by a variety of degenerative changes in the neck, which affect one or more anatomical structures, including intervertebral discs, vertebrae, and spinal canal ligaments. These changes can also lead to structural abnormalities, leading to alterations in alignment, mobility, and stability. The principle unifying problem in this disease, regardless of the types of changes present, is injury to the spinal cord due to compression by static and/or dynamic forces. This review is partitioned into three segments that focus on key elements of the past, the present, and the future in the field, which serve to introduce the focus issue on “Degenerative Cervical Myelopathy and the Aging Spine”. Emerging from this review is that tremendous progress has been made in the field, particularly in recent years, and that there are exciting possibilities for further advancements of patient care.

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“…A more recent study, based specifically on those patients undergoing 3–5 level surgery, from 245 patients in the Quality Outcome Database, provided a similar conclusion, and added that readmission and reoperation (within 1 year) were also equivalent [97]. A more robust, logistic regression model analysis of both CSM North America and CSM International combined datasets also proved equivalent outcomes and complication rates up to 2 years after surgery [98]. The CSM-S trial, a randomized control trial to assess anterior versus posterior decompression in equivalent patients in DCM, completed patient enrolment in 2018 and the results are expected soon after follow up is collected [99].…”

Section: Latest Advances and Future Directions Of Surgical Treatmentsmentioning

confidence: 87%

“…The CSM-S trial, a randomized control trial to assess anterior versus posterior decompression in equivalent patients in DCM, completed patient enrolment in 2018 and the results are expected soon after follow up is collected [99]. This should provide a more definitive insight, but the evidence to date suggests surgeon’s experience in choosing the correct approach provides equivalent outcomes and complications whether anterior or posterior [96-98].…”

Section: Latest Advances and Future Directions Of Surgical Treatmentsmentioning

confidence: 99%

Degenerative Cervical Myelopathy; A Review of the Latest Advances and Future Directions in Management

et al. 2019

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The assessment, diagnosis, operative and nonoperative management of degenerative cervical myelopathy (DCM) have evolved rapidly over the last 20 years. A clearer understanding of the pathobiology of DCM has led to attempts to develop objective measurements of the severity of myelopathy, including technology such as multiparametric magnetic resonance imaging, biomarkers, and ancillary clinical testing. New pharmacological treatments have the potential to alter the course of surgical outcomes, and greater innovation in surgical techniques have made surgery safer, more effective and less invasive. Future developments for the treatment of DCM will seek to improve the diagnostic accuracy of imaging, improve the objectivity of clinical assessment, and increase the use of surgical technology to ensure the best outcome is achieved for each individual patient.

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Comparison of Anterior and Posterior Surgery for Degenerative Cervical Myelopathy

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 81 publications

References 37 publications

Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis

Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis

Degenerative Cervical Myelopathy: A Brief Review of Past Perspectives, Present Developments, and Future Directions

Degenerative Cervical Myelopathy; A Review of the Latest Advances and Future Directions in Management

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