Kato So, Nouri Aria, Wu Dongjin, Nori Satoshi, Tetreault Lindsay, Fehlings Michael G
1Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
J Bone Joint Surg Am. 2017 Jun 21;99(12):1013-1021. doi: 10.2106/JBJS.16.00882.
Surgeons often choose between 2 different approaches (anterior and posterior) for surgical treatment of degenerative cervical myelopathy on the basis of imaging features of spinal cord compression, the number of levels affected, and the spinal alignment. However, there is a lack of consensus on which approach is preferable. The objective of the present study was to use magnetic resonance imaging (MRI)-based propensity-score-matched analysis to compare postoperative outcomes between the anterior and posterior surgical approaches for degenerative cervical myelopathy.
A total of 757 patients were enrolled in 2 prospective multicenter AOSpine studies, which involved 26 international sites. Preoperative MRIs were reviewed to characterize the causes of the cord compression, including single-level disc disease, multilevel disc disease, ossification of the posterior longitudinal ligament, enlargement of the ligamentum flavum, vertebral subluxation/spondylolisthesis, congenital fusion, number of compressed levels, or kyphosis. The propensity to choose anterior decompression was calculated using demographic data, preoperative MRI findings, and the modified Japanese Orthopaedic Association (mJOA) scores in a logistic regression model. We then performed 1-to-1 matching of patients who had received anterior decompression with those who had the same propensity score but had received posterior decompression to compare 2-year postoperative outcomes and 30-day perioperative complication rates between the 2 groups after adjustment for background characteristics.
A total of 435 cases were included in the propensity score calculation, and 1-to-1 matching resulted in 80 pairs of anterior and posterior surgical cases; 99% of these matched patients had multilevel compression. The anterior and posterior groups did not differ significantly in terms of the postoperative mJOA score (15.1 versus 15.3, p = 0.53), Neck Disability Index (20.5 versus 24.1, p = 0.44), or Short Form-36 (SF-36) Physical Component Summary (PCS) score (41.9 versus 40.9, p = 0.30). The overall rates of perioperative complications were similar between the 2 groups (16% versus 11%, p = 0.48); however, dysphagia/dysphonia was reported only in the anterior group whereas surgical site infection and C5 radiculopathy were reported only in the posterior group.
Anterior and posterior decompression for degenerative cervical myelopathy resulted in similar postoperative outcomes and rates of complications.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
外科医生在对退行性颈椎脊髓病进行手术治疗时，常根据脊髓受压的影像学特征、受累节段数量和脊柱排列情况，在两种不同的手术入路（前路和后路）之间做出选择。然而，对于哪种入路更优尚无共识。本研究的目的是使用基于磁共振成像（MRI）的倾向评分匹配分析，比较退行性颈椎脊髓病前路和后路手术入路的术后结果。
共有757例患者纳入两项前瞻性多中心AOSpine研究，涉及26个国际研究点。对术前MRI进行回顾，以明确脊髓受压的原因，包括单节段椎间盘疾病、多节段椎间盘疾病、后纵韧带骨化、黄韧带增厚、椎体半脱位/椎体滑脱、先天性融合、受压节段数量或脊柱后凸。在逻辑回归模型中，使用人口统计学数据、术前MRI结果和改良日本骨科协会（mJOA）评分计算选择前路减压的倾向。然后，我们对接受前路减压的患者与倾向评分相同但接受后路减压的患者进行1:1匹配，以比较两组在调整背景特征后的2年术后结果和30天围手术期并发症发生率。
共有435例病例纳入倾向评分计算，1:1匹配产生80对前路和后路手术病例；这些匹配患者中99%有多节段受压。前路组和后路组在术后mJOA评分（15.1对15.3，p = 0.53）、颈部残疾指数（20.5对24.1，p = 0.44）或简明健康调查问卷36项（SF-36）身体成分总结（PCS）评分（41.9对40.9，p = 0.30）方面无显著差异。两组围手术期并发症的总体发生率相似（16%对11%，p = 0.48）；然而，吞咽困难/发音障碍仅在前路组中报告，而手术部位感染和C5神经根病仅在后路组中报告。
退行性颈椎脊髓病的前路和后路减压术后结果及并发症发生率相似。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
