Patient-Reported Outcomes Following Anterior and Posterior Surgical Approaches for Multilevel Cervical Myelopathy

Abstract

Study Design. Retrospective cohort. Objective. To compare health-related quality of life (HRQoL) outcomes between approach techniques for the treatment of multilevel degenerative cervical myelopathy (DCM). Summary of Background Data. Both anterior and posterior approaches for the surgical treatment of cervical myelopathy are successful techniques in the treatment of myelopathy. However, the optimal treatment has yet to be determined, especially for multilevel disease, as the different approaches have separate complication profiles and potentially different impacts on HRQoL metrics. Materials and Methods. Retrospective review of a prospectively managed single institution database of patient-reported outcome measures after 3 and 4-level anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) for DCM. The electronic medical record was reviewed for patient baseline characteristics and surgical outcomes whereas preoperative radiographs were analyzed for baseline cervical lordosis and sagittal balance. Bivariate and multivariate statistical analyses were performed to compare the two groups. Results. We identified 153 patients treated by ACDF and 43 patients treated by PCDF. Patients in the ACDF cohort were younger (60.1 ± 9.8 vs. 65.8 ± 6.9 yr; P < 0.001), had a lower overall comorbidity burden (Charlson Comorbidity Index: 2.25 ± 1.61 vs. 3.07 ± 1.64; P = 0.002), and were more likely to have a 3-level fusion (79.7% vs. 30.2%; P < 0.001), myeloradiculopathy (42.5% vs. 23.3%; P = 0.034), and cervical kyphosis (25.7% vs.7.69%; P = 0.027). Patients undergoing an ACDF had significantly more improvement in their neck disability index after surgery (−14.28 vs. −3.02; P = 0.001), and this relationship was maintained on multivariate analysis with PCDF being independently associated with a worse neck disability index (+8.83; P = 0.025). Patients undergoing an ACDF also experienced more improvement in visual analog score neck pain after surgery (−2.94 vs. −1.47; P = 0.025) by bivariate analysis. Conclusions. Our data suggest that patients undergoing an ACDF or PCDF for multilevel DCM have similar outcomes after surgery.

Cervical alignment and clinical outcome of anterior cervical discectomy and fusion vs. anterior cervical corpectomy and fusion in local kyphotic cervical spondylotic myelopathy

“…The incidence rate of axial symptoms (AS) can be as high as 29.9% after ACDF [ 22 ] and 46.7% after ACCF [ 23 ], respectively. The pathophysiology of neck pain is complicated, and most likely associated with disc degeneration, herniation, and the loss of cervical lordosis, as well as bio-mechanical abnormality of facet joints, muscles, and ligaments [ 24 , 25 ]. The loss of cervical lordosis and even cervical kyphosis may gradually develop due to the long-term bad lifestyle.…”

Anterior vs Posterior Surgery for Patients With Degenerative Cervical Myelopathy: An Observational Study From the Canadian Spine Outcomes and Research Network

“…We implemented a minimum clinically important difference (MCID) of 15 of 100, which Carreon et al established using an anchor-based technique. 3,22 To ensure our study would be adequately powered, we performed an a priori sample size calculation, which showed that at least 50 patients in each group would reliably detect a difference in means of 15 points with 80% power and an alpha of 0.05. 23…”

“…We implemented a minimum clinically important difference (MCID) of 15 of 100, which Carreon et al established using an anchorbased technique. 3,22 To ensure our study would be adequately powered, we performed an a priori sample size calculation, which showed that at least 50 patients in each group would reliably detect a difference in means of 15 points with 80% power and an alpha of 0.05. 23 Secondary outcomes included changes in neurological function according to the modified Japanese Orthopedic Association (mJOA) scale, neck and arm pain according to Numerical Rating Scales (scored from 0 to 10 points), and quality of life according to Short Form 12 Physical and Mental Component Summaries and EuroQol 5D, from baseline to 1 year after surgery.…”

“…or patients with progressive degenerative cervical myelopathy (DCM), surgery is the only effective treatment option to improve or halt progression of disability, but the advantages and disadvantages of anterior vs posterior surgical approaches remain uncertain. 1,2 Some studies have suggested that anterior surgery may be associated with greater improvements in functional outcomes with fewer serious adverse events, [3][4][5][6] but a recent randomized controlled trial did not confirm these benefits. 7 The AO Spine RECODE-DCM (REsearch Objectives and COmmon Data Elements for Degenerative Cervical Myelopathy) project is an international, multi-stakeholder initiative that aims to help accelerate knowledge discovery and improve outcomes for patients with DCM.…”

“…For patients with progressive degenerative cervical myelopathy (DCM), surgery is the only effective treatment option to improve or halt progression of disability, but the advantages and disadvantages of anterior vs posterior surgical approaches remain uncertain. 1,2 Some studies have suggested that anterior surgery may be associated with greater improvements in functional outcomes with fewer serious adverse events, 3-6 but a recent randomized controlled trial did not confirm these benefits. 7…”