A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Minimally invasive posterior cervical decompression (miPCD) has been described in several case series with promising preliminary results. The object of the current study was to compare the clinical outcomes between patients undergoing miPCD with anterior cervical discectomy and instrumented fusion (ACDFi).</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A retrospective study of 74 patients undergoing surgery (45 using miPCD and 29 using ACDFi) for myelopathy was performed. Outcomes were categorized into short-term, intermediate, and long-term follow-up, corresponding to averages of 1.7, 7.7, and 30.9 months, respectively. Mean scores for the Neck Disability Index (NDI), neck visual analog scale (VAS) score, SF-12 Physical Component Summary (PCS), and SF-12 Mental Component Summary (MCS) were compared for each follow-up period. The percentage of patients meeting substantial clinical benefit (SCB) was also compared for each outcome measure.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Baseline patient characteristics were well-matched, with the exception that patients undergoing miPCD were older (mean age 57.6 ± 10.0 years [miPCD] vs 51.1 ± 9.2 years [ACDFi]; p = 0.006) and underwent surgery at more levels (mean 2.8 ± 0.9 levels [miPCD] vs 1.5 ± 0.7 levels [ACDFi]; p &lt; 0.0001) while the ACDFi patients reported higher preoperative neck VAS scores (mean 3.8 ± 3.0 [miPCD] vs 5.4 ± 2.6 [ACDFi]; p = 0.047). The mean PCS, NDI, neck VAS, and MCS scores were not significantly different with the exception of the MCS score at the short-term follow-up period (mean 46.8 ± 10.6 [miPCD] vs 41.3 ± 10.7 [ACDFi]; p = 0.033). The percentage of patients reporting SCB based on thresholds derived for PCS, NDI, neck VAS, and MCS scores were not significantly different, with the exception of the PCS score at the intermediate follow-up period (52% [miPCD] vs 80% [ACDFi]; p = 0.011).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The current report suggests that the optimal surgical strategy in patients requiring dorsal surgery may be enhanced by the adoption of a minimally invasive surgical approach that appears to result in similar clinical outcomes when compared with a well-accepted strategy of ventral decompression and instrumented fusion. The current results suggest that future comparative effectiveness studies are warranted as the miPCD technique avoids instrumented fusion.</jats:p></jats:sec>

Correlation of Clinical and Radiological Outcome After Anterior Cervical Discectomy and Fusion With a Polyetheretherketone Cage

“…1 ). There are several studies supporting the concept that NDI reduction is associated to pain reduction through the postoperative period [ 10 , 16 , 23 - 25 ] and our study results strongly support this. More specifically, there was statistically significant correlation between these variables (NDI and NRS) in the preoperatively obtained scores as well as in the postoperatively obtained scores (6- and 12-month).…”

A Long-Term Control Study of the Treatment of Cervical Radiculopathy by Percutaneous Endoscopic Posterior Cervical Discectomy and Anterior Cervical Decompression, Bone Graft Fusion and Internal Fixation

“…Both of which can effectively remove nerve root compression to relieve symptoms, which is similar to previous ndings [21,23,26,27]. Compared with ACDF, PEPCD can signi cantly reduce the surgical trauma (reduced blood loss, shortened hospital stay), to promote postoperative rehabilitation (Back to work / Full activity), reduce economic and social burden (lower hospitalization costs) [20,31]. We found that the ACDF and PEPCD can signi cant improve C2-7 lordosis, and the C2-7 lordosis improved more in the ACDF group when compared with that of PEPCD.…”

“…In this study, we con rmed that the clinical effect of PEPCD in the treatment of CSR is equivalent to that of ACDF, and the surgical trauma is smaller and the postoperative recovery is faster. PEPCD surgery is limited by its own technical characteristics, adapted to cervical disc herniation and small joint hyperplasia induced intervertebral foramen stenosis; contraindications include central cervical disc herniation, cervical spondylotic myelopathy, posterior longitudinal ligament ossi cation or cervical unstable and so on [20,44]. However, with the development of endoscopic techniques, PEPCD has also been applied to multi-segment cervical spondylosis [27], cervical spondylotic myelopathy, and achieved good early postoperative effect.…”

Rare manifestation of common disease with an unique method of minimally invasive spine stabilization: Cervical 2–3 facet lesion

“…PubMed search of literature threw very little light on this technique; rather the minimally invasive spinal stabilization techniques are more often being used to treat spinal degenerative conditions. [ 9 10 11 ] Through this case and technique, we attempt to (convey) that minimally invasive posterior cervical stabilization techniques have to be considered more often in individualized cases which are surgically amenable by this technique to make the procedures less morbid and speedy recovery for the patients.…”