Spine Surgery Division, Department of Neurosurgery, Sheba Medical Centre, Ramat-Gan, Israel, affiliated to Sackler Medical School, Tel-Aviv University, Israel.
Hez programme, Sackler Medical School, Tel-Aviv University, Ramat-Gan, Israel.
Neurol Neurochir Pol. 2022;56(5):404-409. doi: 10.5603/PJNNS.a2022.0052. Epub 2022 Jul 8.
Degenerative cervical myelopathy (DCM) is a common condition often treated by surgical decompression and fusion. The objective of this paper was to compare short-term post-operative complication rates of patients with multi-level DCM treated with decompression and fusion using either an anterior or a posterior cervical approach.
A retrospective evaluation of patients' charts, imaging studies and operative reports of patients operated for multilevel subaxial DCM from 2011 to 2016 at a single institution was performed. Patients who were operated upon for the treatment of three stenosed spinal levels or above and who underwent anterior cervical discectomy and fusion, or anterior cervical corpectomy and fusion, or posterior cervical laminectomy and fusion, were included. Short-term post-operative complications were compared between the anterior and posterior approaches.
Overall, 207 patients were included in this study. 156 were operated via an anterior approach and 51 via a posterior approach. The mean number of treated levels was 3.4 and 4.3 for the anterior and posterior approach groups, respectively (p < 0.001). In the posterior approach group, the proportion of stenosed spinal levels within all operated levels was significantly lower than in the anterior approach group (p = 0.025). Early post-operative neurological status change was favourable for both groups. Deep wound infection rate was significantly higher in the posterior approach group (7.8% vs. none; p = 0.001).
Posterior cervical laminectomy and fusion is significantly associated with an increased rate of deep wound infection and wound revision surgery compared to the anterior approach. We recommend the anterior approach as the valid option in treating multi-level DCM.
退行性颈椎脊髓病（DCM）是一种常见疾病，通常采用手术减压和融合治疗。本文旨在比较多节段 DCM 患者采用前路或后路颈椎手术治疗后的短期术后并发症发生率。
对 2011 年至 2016 年在一家医疗机构接受多节段下颈椎 DCM 手术治疗的患者的病历、影像学研究和手术报告进行回顾性评估。研究对象为接受前路颈椎间盘切除术和融合术、前路颈椎椎体切除术和融合术或后路颈椎椎板切除术和融合术治疗 3 个或 3 个以上狭窄节段的患者。比较前路和后路两种手术方法的短期术后并发症。
共有 207 例患者纳入本研究，其中 156 例行前路手术，51 例行后路手术。前路组和后路组的平均治疗节段数分别为 3.4 个和 4.3 个（p < 0.001）。后路组中所有手术节段的狭窄比例明显低于前路组（p = 0.025）。两组患者术后早期神经状态均有改善。后路组深部伤口感染率明显高于前路组（7.8% vs. 0；p = 0.001）。
与前路手术相比，后路颈椎椎板切除术和融合术与深部伤口感染和伤口修复手术的发生率增加显著相关。我们建议将前路手术作为治疗多节段 DCM 的有效选择。
