Anterior Versus Posterior Surgical Approaches to Treat Cervical Spondylotic Myelopathy Outcomes of the Prospective Multicenter AOSpine North America CSM Study in 264 Patients

作者：Fehlings Michael G^*; Barry Sean; Kopjar Branko; Yoon Sangwook Tim; Arnold Paul; Massicotte Eric M; Vaccaro Alexander; Brodke Darrel S; Shaffrey Christopher; Smith Justin S; Woodard Eric; Banco Robert J; Chapman Jens; Janssen Michael; Bono Christopher; Sasso Rick; Dekutoski Mark; Gokaslan Ziya L

来源：Spine, 2013, 38(26): 2247-2252.

DOI：10.1097/BRS.0000000000000047

• surgery
• cervical spondylotic myelopathy
• CSM
• multicenter trial
• surgical outcomes

Study Design. A prospective observational multicenter study. %26lt;br%26gt;Objective. To help solve the debate regarding whether the anterior or posterior surgical approach is optimal for patients with cervical spondylotic myelopathy (CSM). %26lt;br%26gt;Summary of Background Data. The optimal surgical approach to treat CSM remains debated with varying opinions favoring anterior versus posterior surgical approaches. We present an analysis of a prospective observational multicenter study examining outcomes of surgical treatment for CSM. %26lt;br%26gt;Methods. A total of 278 subjects from 12 sites in North America received anterior/posterior or combined surgery at the discretion of the surgeon. This study focused on subjects who had either anterior or posterior surgery (n = 264, follow-up rate, 87%). Outcome measures included the modifi ed Japanese Orthopedic Assessment scale, the Nurick scale, the Neck Disability Index, and the ShortForm 36 (SF-36) Health Survey version 2 Physical and Mental Component Scores. %26lt;br%26gt;Results. One hundred and sixty-nine patients were treated anteriorly and 95 underwent posterior surgery. Anterior surgical cases were younger and had less severe myelopathy as assessed by mJOA and Nurick scores. There were no baseline differences in Neck Disability Index or SF-36 between the anterior and posterior cases. Improvement in the mJOA was signifi cantly lower in the anterior group than posterior group (2.47 vs. 3.62, respectively, P %26lt; 0.01), although the groups started at different levels of baseline impairment. The extent of improvement in the Nurick Scale, Neck Disability Index, SF-36 version 2 Physical Component Score, and SF-36 version 2 Mental Component Score did not differ between the groups. %26lt;br%26gt;Conclusion. Patients with CSM show signifi cant improvements in several health-related outcome measures with either anterior or posterior surgery. Importantly, patients treated with anterior techniques were younger, with less severe impairment and more focal pathology. We demonstrate for the fi rst time that, when patient and disease factors are controlled for, anterior and posterior surgical techniques have equivalent effi cacy in the treatment of CSM.

• 出版日期2013-12-15