Surgery in multisegmental cervical spondylotic myelopathy: Outcome analysis in a series of 65 patients

Abstract

Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or posterior approaches. The aim of study was to analyze the surgical outcomes of MS-CSM treated by either anterior cervical discectomy with fusion and cervical plating (ACDF) or cervical laminoplasty (LP). Sixty-five patients with MS-CSM (two or more levels) underwent either ACDF (n=13) or LP (n=52). ACDF was performed in patients having these criteria: (i) three or less levels involved, (ii) myeloradiculopathy, (iii) pre-dominant anterior compression radiologically, (iv) <50 years age. LP was chosen in: (i) more than three levels involved (ii) posterior compression radiologically, (iii) >50 years age. Patients were evaluated pre- and post-operatively on the basis of modified Japanese Orthopedic Association (mJOA) scoring and Hirabayashi formula. Thirty-five patients were followed up (8 in ACDF group and 27 in LP group). The mean follow-up period was 37.5 months (12.5-54 months). The mean pre-operative mJOA score in the ACDF group and the LP group was 11±2.62 and 10.6±2.04, respectively. The mean final post-operative mJOA score in the ACDF group (n=8) in follow-up was 14.12±2.36 (P<0.05) and in the LP group (n=27) was 14.63±1.64 (P<0.05). 86% had good-to-excellent outcome while 8.5% had poor outcome. Overall, the mean recovery was 64.73±18.9%. On analyzing two groups separately, the mean recovery in the ACDF group was 59.62±24.2, while in the LP group was 66.25±17.3 (P<0.05). The choice of ACDF and LP in MS-CSM depends on pre-operative clinical and radiological parameters. If the surgical approach is chosen correctly, the surgery in MS-CSM can result in significant improvement in the clinical outcome of these patients.