Anterior Cervical Discectomy and Fusion with and without Plating versus Laminectomy with and without Fusion for Multilevel Cervical Spondylotic Myelopathy: A Comparative Study

Abstract

Abstract Background Cervical spodylotic myelopathy (CSM) is a chronic progressive spinal compression that usually accompanies age-related degeneration of the cervical spine and represents one of the most common causes of spinal cord dysfunction. Surgical intervention is the foundation of management in symptomatic cases, but the approach of choice is constantly contentious. Purpose The aim of this study is to evaluate and appraise different surgical approaches for multilevel cervical spondylotic myelopathy (Anterior cervical discectomy and fusion with or without plating and Laminectomy with and without fusion) regarding the perioperative data, clinical outcomes, complications rates and radiographic parameters. Patients and Methods This work is a prospective comparative study of 80 patients assigned into four groups. The first group (n = 20) underwent ACDF only, the second group (n = 20) underwent ACDF with anterior plate, the third group (n = 20) underwent laminectomy alone and the fourth group (n = 20) underwent laminectomy with lateral mass fusion. Patients were followed up for 12 months duration using modified Japanese orthopedic score (mJAO), Neck disability index (NDI), Visual analogue scale (VAS) and short form 36 (SF-36) in addition to measurement of C2-C7 cobb`s angle to evaluate post-operative cervical sagittal alignment. Results Our results revealed that all the four surgical techniques were associated with functional improvement compared to preoperative parameters. Anterior approaches were associated with better restoration of lordosis and better overall quality of life than posterior approaches. Recommendations We recommend designing randomized controlled trials in the future with longer follow-up periods to address long-term outcomes and/or complications.