Abstract
Background
The goal of this meta-analysis is to explore the overall efficacy as well as the safety of anterior versus posterior approach for the therapy of patients with multilevel cervical spondylotic myelopathy based on qualified studies.
Methods
Three electronic databases, PubMed, Cochrane, Embase were searched updated to January 2018 to identify all relevant and qualified studies using the index words. The qualified studies were including prospective or retrospective comparative studies. Relative risk (RR) and mean difference (MD) along with 95% confidence interval (95% CI) were used to analyze the main outcomes.
Results
In this meta-analysis, there were a total of 24 studies with 959 patients in the anterior approach group and 1072 patients in the posterior approach group. The final results showed, in comparison of the posterior approach group, the anterior approach group significantly increased the JOA score (SMD: 0.36, 95% CI 0.10–0.62), the operation time (WMD: 49.87, 95% CI 17.67–82.08), and the neurological recovery rate (WMD: 10.55, 95% CI 3.99–17.11) with higher complication rate (RR: 1.53, 95% CI 1.24–1.89). Besides, there was no significant difference of the blood loss (SMD: − 0.40, 95% CI − 1.12 to 0.32) and ROM (SMD: − 0.28, 95% CI − 0.78 to − 0.22) between posterior approach group and anterior approach group.
Conclusions
Studies found a significant increase of JOA score as well as neurological recovery rate by the anterior approach treatment when compared with posterior approach treatment. However, increased operation time and complications could also occur through the anterior approach treatment. More high-quality randomized controlled trials with larger sample size, multi-centric and longer follow-ups are needed to support our current conclusions.
Similar content being viewed by others
References
Young WF (2000) Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Phys 62(5):1064–1070, 73
Edwards CC, Riew KD, Anderson PA, Hilibrand AS, Vaccaro AF (2003) Cervical myelopathy. Current diagnostic and treatment strategies. Spine J 3(1):68–81
Baptiste DC, Fehlings MG (2006) Pathophysiology of cervical myelopathy. Spine J 6(6):190S–190S7S
Chen MC, Yang SH (2014) Choice of surgical approaches for cervical spondylotic myelopathy. J Clin Orthop 17(5):608–613
Zhu B, Xu Y, Liu X, Liu Z, Dang G (2013) Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical. Spine Res Soc 22(7):1583–1593
Hirabayashi K, Bohlman HH (1995) Multilevel cervical spondylosis. Laminoplasty versus anterior decompression. Spine 20(15):1732–1734
Katsumi K, Yamazaki A, Watanabe K, Ohashi M, Shoji H (2013) Analysis of C5 palsy after cervical open-door laminoplasty: relationship between C5 palsy and foraminal stenosis. J Spinal Disord Tech 26(4):177–182
Gu Y, Cao P, Gao R, Tian Y, Liang L, Wang C et al (2014) Incidence and risk factors of C5 palsy following posterior cervical decompression: a systematic review. PloS One 9(8):e101933
Hosono N, Yonenobu K, Ono K (1996) Neck and shoulder pain after laminoplasty. A noticeable complication. Spine 21(17):1969–1973
Heller JG, Edwards CC, Murakami H, Rodts GE (2001) Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine 26(12):1330–1336
Lin D, Zhai W, Lian K, Kang L, Ding Z (2013) Anterior versus posterior approach for four-level cervical spondylotic myelopathy. Orthopedics 36(11):e1431–e1436
Masaki Y, Yamazaki M, Okawa A, Aramomi M, Hashimoto M, Koda M et al (2007) An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament: anterior decompression with spinal fusion versus laminoplasty. J Spinal Disord Tech 20(1):7–13
Kristof RA, Kiefer T, Thudium M, Ringel F, Stoffel M, Kovacs A et al (2009) Comparison of ventral corpectomy and plate-screw-instrumented fusion with dorsal laminectomy and rod-screw-instrumented fusion for treatment of at least two vertebral-level spondylotic cervical myelopathy. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical. Spine Res Soc 18(12):1951–1956
Cabraja M, Abbushi A, Koeppen D, Kroppenstedt S, Woiciechowsky C (2010) Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome. Neurosurg Focus 28(3):E15
Ghogawala Z, Martin B, Benzel EC, Dziura J, Magge SN, Abbed KM et al (2011) Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy. Neurosurgery 68(3):622–630
Hirai T, Okawa A, Arai Y, Takahashi M, Kawabata S, Kato T et al (2011) Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy. Spine 36(23):1940–1947
Liu B, Ma W, Zhu F, Guo CH, Yang WL (2012) Comparison between anterior and posterior decompression for cervical spondylotic myelopathy: subjective evaluation and cost analysis. Orthop Surg 4(1):47–54
Shunzhi Y, Zhonghai L, Fengning L, Zhi C, Tiesheng H (2013) Surgical management of 4-level cervical spondylotic myelopathy. Orthopedics 36(5):e613–e620
Yonenobu K, Hosono N, Iwasaki M, Asano M, Ono K (1992) Laminoplasty versus subtotal corpectomy. A comparative study of results in multisegmental cervical spondylotic myelopathy. Spine 17(11):1281–1284
Lee SH, Ahn Y, Lee JH (2008) Laser-assisted anterior cervical corpectomy versus posterior laminoplasty for cervical myelopathic patients with multilevel ossification of the posterior longitudinal ligament. Photomed Laser Surg 26(2):119–127
Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K et al (2007) Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: part 2: advantages of anterior decompression and fusion over laminoplasty. Spine 32(6):654–660
Chen Y, Guo Y, Lu X, Chen D, Song D, Shi J et al (2011) Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine. J Spinal Disord Tech 24(1):24–30
Salerno EV (1949) Psychological aspects of the gynecological consultation. Prensa Med Argentina 36(46):2403–2411
Wada E, Suzuki S, Kanazawa A, Matsuoka T, Miyamoto S, Yonenobu K (2001) Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years. Spine 26(13):1443–1447
Liu T, Yang HL, Xu YZ, Qi RF, Guan HQ (2011) ACDF with the PCB cage-plate system versus laminoplasty for multilevel cervical spondylotic myelopathy. J Spinal Disord Tech 24(4):213–220
Shibuya S, Komatsubara S, Oka S, Kanda Y, Arima N, Yamamoto T (2010) Differences between subtotal corpectomy and laminoplasty for cervical spondylotic myelopathy. Spinal Cord 48(3):214–220
Hirai T, Yoshii T, Sakai K, Inose H, Yamada T, Kato T et al (2018) Long-term results of a prospective study of anterior decompression with fusion and posterior decompression with laminoplasty for treatment of cervical spondylotic myelopathy. J Orthop Sci 23(1):32–38
Hirai T, Yoshii T, Arai Y, Sakai K, Torigoe I, Maehara H et al (2017) A comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy patients with large anterior compression of the spinal cord. Clin Spine Surg 30(8):E1137–E1142
Ren H, Liu F, Yu D, Cao J, Shen Y, Li X et al (2017) Patterns of neurological recovery after anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of multilevel cervical spondylotic myelopathy. Clin Spine Surg 30(8):E1104–E1110
Shen QF, Xu TT, Xia YP (2016) Comparison of the outcomes between anterior cervical discectomy and fusion versus posterior laminectomy and fusion for the treatment of multi-level cervical spondylotic myelopathy combined with cervical kyphosis. Zhonghua yi xue za zhi 96(47):3800–3804
Ahao B, Wang D, Li HP, He XJ (2016) Case-control study of anterior cervical decompression plus sublevel fusion and posterior cervical laminoDIastv for the treatment of multilevel cervical spondylotic myelopathy. China J Orthop Traumatol 29(3):205–210
Li X, Jiang L, Liu Z, Liu X, Zhang H, Zhou H et al (2015) Different Approaches for treating multilevel cervical spondylotic myelopathy: a retrospective study of 153 cases from a single spinal center. PloS One 10(10):e0140031
Kato S, Nouri A, Wu D, Nori S, Tetreault L, Fehlings MG (2017) Comparison of anterior and posterior surgery for degenerative cervical myelopathy: an MRI-Based Propensity-Score-matched analysis using data from the prospective multicenter AOSpine CSM North America and International Studies. J Bone Joint Surg Am Volume 99(12):1013–1021
Chen Z, Liu B, Dong J, Feng F, Chen R, Xie P et al (2017) A comparison of the anterior approach and the posterior approach in treating multilevel cervical myelopathy: a meta-analysis. Clin Spine Surg 30(2):65–76
Luo J, Cao K, Huang S, Li L, Yu T, Cao C et al (2015) Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy. Spine Res Soc 24(8):1621–1630
Sun Y, Li L, Zhao J, Gu R (2015) Comparison between anterior approaches and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy: a meta-analysis. Clin Neurol Neurosurg 134:28–36
Funding
This study was supported by Key Research Projects in Medical Science (2007) (Grant no. 20170278).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Zhang, L., Chen, J., Cao, C. et al. Anterior versus posterior approach for the therapy of multilevel cervical spondylotic myelopathy: a meta-analysis and systematic review. Arch Orthop Trauma Surg 139, 735–742 (2019). https://doi.org/10.1007/s00402-018-03102-6
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-018-03102-6