Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA.
Spine (Phila Pa 1976). 2019 May 1;44(9):615-623. doi: 10.1097/BRS.0000000000002912.
A retrospective cohort study.
The aim of this study was to identify advantages and disadvantages of the anterior and posterior approaches in the treatment of cervical stenosis and myelopathy.
Both anterior and posterior surgical approaches for cervical stenosis and myelopathy have been shown to result in improvement in health-related outcomes. Despite the evidence, controversy remains regarding the best approach to achieve decompression and correct deformity.
We retrospectively reviewed patients with cervical stenosis and myelopathy who had undergone anterior cervical fusion and instrumentation (n = 38) or posterior cervical laminectomy and instrumentation (n = 51) with at least 6 months of follow-up. Plain radiographs, magnetic resonance imaging, and computed tomography scans, as well as health-related outcomes, including Visual Analog Scale for neck pain, Japanese Orthopedic Association score for myelopathy, Neck Disability Index, and Short Form-36 Health Survey, were collated before surgery and at follow-up (median 12.0 and 12.1 months for anterior and posterior group, respectively).
Both anterior and posterior approaches were associated with significant improvements in all studied quality of life parameters with the exception of general health in the anterior group and energy and fatigue in the posterior group. In the anterior group, follow-up assessment revealed a significant increase in C2-7 lordosis. Both approaches were accompanied by significant increases in C2-7 sagittal balance [sagittal vertical axis (SVA)]. There were two complications in the anterior group and nine complications in the posterior group; the incidence of complications between the two groups was not significantly different.
When the benefits of one approach over the other are not self-evident, the anterior approach is recommended, as it was associated with a shorter hospital stay and more successful restoration of cervical lordosis than posterior surgery.
回顾性队列研究。
本研究旨在确定颈椎狭窄和脊髓病的前路和后路治疗的优缺点。
颈椎狭窄和脊髓病的前路和后路手术均已显示出改善健康相关结果。尽管有证据，但关于实现减压和纠正畸形的最佳方法仍存在争议。
我们回顾性分析了接受前路颈椎融合和内固定术（n=38）或后路颈椎椎板切除术和内固定术（n=51）治疗且至少有 6 个月随访的颈椎狭窄和脊髓病患者。收集术前和随访时的普通 X 线片、磁共振成像和计算机断层扫描，以及健康相关结局，包括颈部疼痛视觉模拟量表、脊髓病日本矫形协会评分、颈部残疾指数和简明 36 健康调查。
前路和后路两种方法均显著改善了所有研究的生活质量参数，除了前路组的一般健康状况和后路组的能量和疲劳状况。在前路组中，随访评估显示 C2-7 后凸明显增加。两种方法均使 C2-7 矢状平衡（矢状垂直轴[SVA]）显著增加。前路组有 2 例并发症，后路组有 9 例并发症；两组并发症的发生率无显著差异。
当一种方法相对于另一种方法的优势不明显时，推荐使用前路方法，因为与后路手术相比，前路方法与较短的住院时间和更成功的颈椎前凸恢复相关。
3 级。
