Skip to main content
Log in

Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to evaluate the clinical outcomes, complications, and surgical trauma between anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy (CSM).

Study design

Systematic review and meta-analysis.

Methods

Randomized controlled trials or non-randomized controlled trials published up to November 2014 that compared the clinical effectiveness of anterior and posterior surgical approaches for the treatment of multilevel CSM were acquired by a comprehensive search in four electronic databases (PubMed, EMBASE, Cochrane Controlled Trial Register and MEDLINE). Exclusion criteria were non-controlled studies, combined anterior and posterior surgery and cervical myelopathy caused by ossification of the posterior longitudinal ligament. The main end points included: recovery rate; Japanese Orthopedic Association (JOA) score; complication rate; reoperation rate; blood loss; operation time and length of stay.

Results

A total of ten studies were included in the meta-analysis; none of which were randomized controlled trials. All of the selected studies were of high quality as indicated by the Newcastle–Ottawa scale. In six studies involving 467 patients, there was no significant difference in the preoperative JOA score between the anterior surgery group and the posterior group [P > 0.05, WMD −0.00 (−0.50, 0.50)]. In four studies involving 268 patients, the postoperative JOA score was significantly higher in the anterior surgery group compared with the posterior surgery group [P < 0.05, WMD 0.79 (0.16, 1.42)]. In five studies involving 420 patients, there was no statistically significant difference in recovery rate between the anterior and posterior surgery groups [P > 0.05, WMD 2.73 (−8.69, 14.15)]. In nine studies involving 804 patients, the postoperative complication rate was significantly higher in the anterior surgery group compared with the posterior surgery group [P = 0.009, OR 1.65 (1.13, 2.39)]. In five studies involving 294 patients, the reoperation rate was significantly higher in the anterior surgery group compared with the posterior surgery group [P = 0.0001, OR 8.67 (2.85, 26.34)]. In the four studies involving 252 patients, the intraoperative blood loss and operation time was significantly higher in the anterior surgery group compared with the posterior surgery group [P < 0.05, WMD −40.25 (−76.96, −3.53) and P < 0.00001, WMD 61.3 (52.33, 70.28)]. In the three studies involving 192 patients, the length of stay was significantly lower in the anterior surgery group compared with the posterior surgery group [P < 0.00001, WMD −1.07 (−2.23, −1.17)].

Conclusions

In summary, our meta-analysis suggested that a definitive conclusion could not be reached regarding which surgical approach is more effective for the treatment of multilevel CSM. Although anterior approach was associated with better postoperative neural function than posterior approach in the treatment of multilevel CSM, there was no apparent difference in the neural function recovery rate between the two approaches. Higher rates of surgery-related complication and reoperation should be taken into consideration when anterior approach is used for patients with multilevel CSM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Young WF (2000) Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician 62(1064–1070):1073

    Google Scholar 

  2. Edwards CN, Riew KD, Anderson PA, Hilibrand AS, Vaccaro AF (2003) Cervical myelopathy. current diagnostic and treatment strategies. Spine J 3:68–81

    Article  PubMed  Google Scholar 

  3. Baptiste DC, Fehlings MG (2006) Pathophysiology of cervical myelopathy. Spine J 6:190S–197S

    Article  PubMed  Google Scholar 

  4. 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. Eur Spine J 22:1583–1593. doi:10.1007/s00586-013-2817-2

    Article  PubMed Central  PubMed  Google Scholar 

  5. Hirabayashi K, Bohlman HH (1995) Multilevel cervical spondylosis. Laminoplasty versus anterior decompression. Spine (Phila Pa 1976) 20:1732–1734

  6. Bartolomei JC, Theodore N, Sonntag VK (2005) Adjacent level degeneration after anterior cervical fusion: a clinical review. Neurosurg Clin N Am 16:575–587. doi:10.1016/j.nec.2005.07.004

    Article  PubMed  Google Scholar 

  7. Li J, Li Y, Kong F, Zhang D, Zhang Y, Shen Y (2014) Adjacent segment degeneration after single-level anterior cervical decompression and fusion: disc space distraction and its impact on clinical outcomes. J Clin Neurosci. doi:10.1016/j.jocn.2014.08.019

    Google Scholar 

  8. 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 26:177–182. doi:10.1097/BSD.0b013e31823db346

    Article  PubMed  Google Scholar 

  9. Gu Y, Cao P, Gao R, Tian Y, Liang L, Wang C, Yang L, Yuan W (2014) Incidence and risk factors of C5 palsy following posterior cervical decompression: a systematic review. PLoS One 9:e101933. doi:10.1371/journal.pone.0101933

    Article  PubMed Central  PubMed  Google Scholar 

  10. Hosono N, Yonenobu K, Ono K (1996) Neck and shoulder pain after laminoplasty. A noticeable complication. Spine (Phila Pa 1976) 21:1969–1973

  11. Lam FC, Irwin BJ, Poskitt KJ, Steinbok P (2009) Cervical spine instability following cervical laminectomies for Chiari II malformation: a retrospective cohort study. Childs Nerv Syst 25:71–76. doi:10.1007/s00381-008-0694-5

    Article  PubMed  Google Scholar 

  12. Yasuoka S, Peterson HA, MacCarty CS (1982) Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg 57:441–445. doi:10.3171/jns.1982.57.4.0441

    Article  CAS  PubMed  Google Scholar 

  13. Guigui P, Benoist M, Deburge A (1998) Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy. Spine (Phila Pa 1976) 23:440–447

  14. 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 24:213–220. doi:10.1097/BSD.0b013e3181e9f294

    Article  PubMed  Google Scholar 

  15. Ghogawala Z, Martin B, Benzel EC, Dziura J, Magge SN, Abbed KM, Bisson EF, Shahid J, Coumans JCE, Choudhri TF, Steinmetz MP, Krishnaney AA, King JT, Butler WE, Barker FG, Heary RF (2011) Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy. Neurosurgery 68:622–631. doi:10.1227/NEU.0b013e31820777cf

    Article  PubMed  Google Scholar 

  16. Kristof RA, Kiefer T, Thudium M, Ringel F, Stoffel M, Kovacs A, Mueller C (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. Eur Spine J 18:1951–1956. doi:10.1007/s00586-009-1110-x

    Article  PubMed Central  PubMed  Google Scholar 

  17. Charles C, Edwards IJGH (2002) Corpectomies versus laminoplasty for multilevel cervical myelopathy. Spine J 11:1168–1175. doi:10.1016/S1529-9430(01)00213-3

    Google Scholar 

  18. Shibuya S, Komatsubara S, Oka S, Kanda Y, Arima N, Yamamoto T (2009) Differences between subtotal corpectomy and laminoplasty for cervical spondylotic myelopathy. Spinal Cord 48:214–220. doi:10.1038/sc.2009.114

    Article  PubMed  Google Scholar 

  19. 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 (Phila Pa 1976) 17:1281–1284

  20. Hirai T, Okawa A, Arai Y, Takahashi M, Kawabata S, Kato T, Enomoto M, Tomizawa S, Sakai K, Torigoe I, Shinomiya K (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 (Phila Pa 1976) 23:1940–1947

    Article  Google Scholar 

  21. 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 (Phila Pa 1976) 26:1443–1447 (1448)

  22. Seng C, Tow BPB, Siddiqui MA, Srivastava A, Wang L, Yew AKS, Yeo W, Khoo SHR, Balakrishnan NMS, Bin Abd Razak HR, Chen JLT, Guo CM, Tan SB, Yue W (2013) Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. Spine J 13:723–731. doi:10.1016/j.spinee.2013.02.038

    Article  PubMed  Google Scholar 

  23. Fehlings MG, Barry S, Kopjar B, Yoon ST, Arnold P, Massicotte EM, Vaccaro A, Brodke DS, Shaffrey C, Smith JS, Woodard E, Banco RJ, Chapman J, Janssen M, Bono C, Sasso R, Dekutoski M, Gokaslan ZL (2013) Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine (Phila Pa 1976) 38:2247–2252

    Article  Google Scholar 

  24. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. Newcastle–Ottawa quality assessment scale for case control studies and cohort studies. www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed 5 April 2014

  25. 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. Eur Spine J 22:1583–1593. doi:10.1007/s00586-013-2817-2

    Article  PubMed Central  PubMed  Google Scholar 

  26. Liu X, Wang H, Zhou Z, Jin A (2014) Anterior decompression and fusion versus posterior laminoplasty for multilevel cervical compressive myelopathy. Orthopedics 37:e117–e122. doi:10.3928/01477447-20140124-12

    Article  PubMed  Google Scholar 

  27. Lawrence BD, Jacobs WB, Norvell DC, Hermsmeyer JT, Chapman JR, Brodke DS (2013) Anterior versus posterior approach for treatment of cervical spondylotic myelopathy a systematic review. Spine (Phila Pa 1976). 38(22 Suppl 1):S173–S182

    Article  Google Scholar 

  28. Liu X, Min S, Zhang H, Zhou Z, Wang H, Jin A (2014) Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: a systematic review and meta-analysis. Eur Spine J 23:362–372. doi:10.1007/s00586-013-3043-7

    Article  PubMed Central  PubMed  Google Scholar 

  29. Liu T, Xu W, Cheng T, Yang H (2011) Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review. Eur Spine J 20(2):224–235

    Article  PubMed Central  PubMed  Google Scholar 

  30. Xu J, Zhang K, Ma X, Yin Q, Wu Z, Xia H, Wang Z (2011) Systematic review of cohort studies comparing surgical treatment for multilevel ossification of posterior longitudinal ligament anterior vs posterior approach. Orthopedics 34(8):e397–e402

    PubMed  Google Scholar 

Download references

Acknowledgments

The present study was financially supported by National Program on Key Basic Research Project (973 Program; Grant No. 2012CB619105).

Conflict of interest

The authors declare that they have no conflicts of interest concerning this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xuenong Zou.

Additional information

J. Luo, K. Cao and S. Huang equally contributed to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luo, J., Cao, K., Huang, S. et al. Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy. Eur Spine J 24, 1621–1630 (2015). https://doi.org/10.1007/s00586-015-3911-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-015-3911-4

Keywords

Navigation