A Comparative Study Of Functional And Radiological Outcomes Between Anterior Cervical Decompression Fusion With Anterior Plate And2Different Posterior Discompression Approaches In The Treatment Of Multilevel Cervical Spondylotic Myelopathy

Objective： Multilevel cervical spondylotic myelopathy (MCSM) refers to thecomplex pathologic changes, with more than3levels involved, resulting inmultilevel spinal cord and sac compression with corresponding clinical symptoms.Anterior approaches include ACDF and ACCF, while main posterior approaches arelaminoplasty and laminectomy. Each of the different surgical approaches hasdifferent advantages and disadvantages. Controversy exists concerning the choice ofsurgical approach in the treatment of multilevel CSM. Most of the current studiesfocus on the comparison of clinical outcomes of different methods instead ofradiological images, furthermore the comparative studies come from more than1spine center remain rare. Therefore, the first part of this study intends to comparethe functional and radiological outcomes based on the recurrent materials come from2different spine centers in Beijing and in Germany, respectively. The purpose of thesecond part in this study is to identify the effectiveness of posterior extensivesemi-laminectomy compared with classic posterior laminoplasty in treatment ofMCSM.Methods：All the clinical data collected from2different spine centers in Beijing andin Germany, respectively. All the patients were suffered with MCSM and treatedwith anterior decompression and fusion (Germany) and posterior laminoplasty(Beijing). Retrospective comparative study was made to find out the differences infunctional and radiological outcomes between two different approaches, such as painor numbness JOA score, Pavlov ratio, range of motion and cervical curvature index. Besides these, intraoperative blood loss and duration of operation time were alsobeen recorded. In the second part of the study, we carried out a small sample ofrandomized controlled clinical trials. All the data of the patients were collected fromour spine center and the effectiveness of posterior semi-laminectomy was made bythe way of comparison with laminoplasty from different aspects in both functionaland radiological outcomes.Results： Both anterior decompression fusion and posterior laminoplasty cansignificantly improve the neurological function of the patients. The patients withcongenital spinal stenosis could reach satisfying outcomes after accepting theposterior laminoplasty. The intraoperative blood loss in AG was significantly lessthan LPG, but the duration of operation was significantly longer than LPG due to thedecompression of long levels. Postoperative CCI was significantly improvedcompared with preoperative CCI in AG. Range of motion didn’t show significantlydifferent either in two groups or pre-and postoperatively. The incidence ofcomplications between2groups was not significant. Duration of operation time inLPG was shorter than AG, meanwhile, blood loss was much more than AG. Thepreoperative intramedullary hyperintense in MRI showed no effect to neurologicaloutcomes. Two different posterior decompression methods had the similarimprovement in JOA score postoperatively. CCI and range of motion were nosignificant changes either pre-and postoperatively or between two groups. Withrespect to the ability in spinal canal extension, there was significantly differentbetween2groups, LP was better than LN. LN had the much shorter duration ofoperation time, less intraoperative blood loss, lower incidence of axial symptom andhospital stay cost.Conclusions：Both anterior decompression fusion and laminoplasty could reachsatisfying neurological improvement in treatment of MCSM. Anterior approach hadabetter ability to restore the height of anterior column and postoperative cervicalcurvature, but longer duration of operation time is one of the shortages due tocomplex direct decompression of long levels. Therefore, for aged people with different comorbidities, posterior laminoplasty is a good choice, while anteriorapproache are much more suitable for the patient with preoperative loss of cervicalcurvature and with radiculopathy. The neurological improvement after laminoplastyand extensive semi-laminectomy are similar in treatment of MCSM. Laminoplastyhas more advantage in the ability of spinal canal extension, for this reason, it is betterto be used in the circumstance of severe spinal canal stenosis, such as CSMcombined with OPLL, OYL or congenital spinal canal stenosis.