Similar results seen with anterior, posterior approaches for cervical spondylotic myelopathy

Clinically insignificant differences were found between the groups for mJOA and SF36v2 scores.

Issue: February 2013

DALLAS — Investigators who studied 264 patients with cervical spondylotic myelopathy treated at 12 centers in North America found the use of posterior and anterior surgical approaches yielded comparable outcomes.

“When we controlled for the confounders, by and large, the treatments are roughly the same,” Michael G. Fehlings, MD, PhD, FRCSC, of Toronto Western Hospital in Ontario, Canada, said during his presentation at the North American Spine Society Annual Meeting.

Surgical treatments

Fehlings and colleagues prospectively studied 169 patients with cervical spondylotic myelopathy who were treated with an anterior approach using a combination of discectomy and corpectomy with instrumented fusion and 95 patients who had a posterior surgical approach of either laminectomy and fusion or laminoplasty. Patients included in the study had a modified Japanese Orthopaedic Assessment (mJOA) score between seven and 16.

“We wanted to avoid patients who had extraordinarily severe impairment or those who had minimal impairment,” Fehlings said. The researchers excluded patients who had undergone circumferential surgery. Outcome measures included the mJOA, Nurick scale, Neck Disability Index (NDI) and SF36v2 Physical (PCS) and Mental Component Scores (MCS).

Analyses

After an unadjusted multivariate analysis, the investigators noted that patients in the anterior group were a decade younger, had less impairment, higher mJOA scores, lower Nurick scale scores and fewer focal pathologies. However, they found no significant differences between the study groups in terms of gender and smoking status. Both groups showed significant improvements in Nurick, NDI, and physical and mental SF36v2 scores.

After adjusting for confounders, the researchers found differences between the groups in the mJOA and SF36v2 scores, but “these slight differences [were] below the minimally critically important differences” and were not “clinically important,” Fehlings said.

Complications rates, which were mainly neurological in nature, were similar between the groups. The most common complication was a delayed C5 palsy.

The researchers found higher infection rates in the posterior group and the higher incidences of dysphagia and dysphonia in the anterior group, which Fehlings said was expected.

“Overall, anterior and posterior techniques are effective for treating cervical spondylotic myelopathy and surgeons seem to be choosing anterior surgery preferentially for younger patients with more focal pathology and choosing posterior techniques for older patients with multilevel disease,” Fehlings said. – by Renee Blisard Buddle

Reference:

Fehlings MG. Paper #1. Presented at: North American Spine Society Annual Meeting; Oct. 24-27, 2012; Dallas.

For more information:

Michael G. Fehlings, MD, PhD, FRCSC, can be reached at Toronto Western Hospital, West Wing, 4th Floor, Rm 4WW449, 399 Bathurst St., Toronto, Ontario, Canada M5T 2S8; email: michael.fehlings@uhn.ca.
Disclosure: Fehlings receives royalties from, is a consultant for and receives fellowship support from DePuy Spine.