Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Germany.
Neurosurg Focus. 2010 Mar;28(3):E15. doi: 10.3171/2010.1.FOCUS09253.
OBJECT: A variety of anterior, posterior, and combined approaches exist to decompress the spinal cord, restore sagittal alignment, and avoid kyphosis, but the optimal surgical strategy remains controversial. The authors compared the anterior and posterior approach used to treat multilevel cervical spondylotic myelopathy (CSM), focusing on sagittal alignment and clinical outcome. METHODS: The authors studied 48 patients with CSM who underwent multilevel decompressive surgery using an anterior or posterior approach with instrumentation (24 patients in each group), depending on preoperative sagittal alignment and direction of spinal cord compression. In the anterior group, a 1-2-level corpectomy was followed by placement of an expandable titanium cage. In the posterior group, a multilevel laminectomy and posterior instrumentation using lateral mass screws was performed. Postoperative radiography and clinical examinations were performed after 1 week, 12 months, and at last follow-up (range 15-112 months, mean 33 months). The radiological outcome was evaluated using measurement of the cervical and segmental lordosis. RESULTS: Both the posterior multilevel laminectomy (with instrumentation) and the anterior cervical corpectomy (with instrumentation) improved clinical outcome. The anterior group had a significantly lower preoperative cervical and segmental lordosis than the posterior group. The cervical and segmental lordosis improved in the anterior group by 8.8 and 6.2 degrees, respectively, and declined in the posterior group by 6.5 and 3.8 degrees, respectively. The loss of correction was higher in the anterior than in the posterior group (-2.0 vs -0.7 degrees, respectively) at last follow-up. CONCLUSIONS: These results demonstrate that both anterior and posterior decompression (with instrumentation) are effective procedures to improve the neurological outcome of patients with CSM. However, sagittal alignment may be better restored using the anterior approach, but harbors a higher rate of loss of correction. In cases involving a preexisting cervical kyphosis, an anterior or combined approach might be necessary to restore the lordotic cervical alignment.
目的：存在多种前路、后路和联合入路来对脊髓进行减压、恢复矢状面排列并避免后凸畸形，但最佳手术策略仍存在争议。作者比较了用于治疗多节段脊髓型颈椎病（CSM）的前路和后路，重点关注矢状面排列和临床结果。
方法：作者研究了 48 例接受前路或后路减压手术（每组 24 例）治疗的多节段 CSM 患者，手术方式取决于术前矢状面排列和脊髓受压的方向。前路组进行 1-2 个节段的椎体次全切除，然后放置可扩张钛网笼。后路组行多节段椎板切除和使用侧块螺钉的后路内固定。术后 1 周、12 个月和末次随访（15-112 个月，平均 33 个月）时进行术后影像学和临床检查。通过测量颈椎和节段前凸角来评估影像学结果。
结果：后路多节段椎板切除（伴内固定）和前路颈椎椎体次全切除（伴内固定）均改善了临床结果。前路组术前颈椎和节段前凸角明显低于后路组。前路组颈椎和节段前凸角分别增加了 8.8°和 6.2°，后路组则分别减少了 6.5°和 3.8°。末次随访时前路组的矫正丢失量高于后路组（分别为-2.0°和-0.7°）。
结论：这些结果表明，前路和后路减压（伴内固定）均为改善 CSM 患者神经功能结果的有效方法。然而，前路手术可能更有利于恢复矢状面排列，但矫正丢失的风险更高。在存在颈椎前凸丢失的情况下，可能需要前路或联合入路来恢复颈椎的前凸排列。
Spine J. 2013-3-27
J Spinal Disord Tech. 2012-4
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