Background: Using anterior or posterior surgery for multilevel cervical spondylotic myelopathy continues to be the subject of considerable debate. Studies on the comparison of the 2 approaches are limited and few studies focus on anterior cervical discectomy and fusion (ACDF) versus open door laminoplasty(ODL).
Study design: A prospective study.
Objective: To compare the clinical outcomes, radiographic changes, and complications of patients with multilevel cervical spondylotic myelopathy who underwent ACDF and ODL in lordotic cervical spine.
METHODS: We evaluated 40 patients (20 patients inthe ACDF group and 20 patients in the ODL group) at our institution from September 2005 to December 2008. They were followed up for minimum 2 years.The clinical outcomes(Nurick grade and JOA score), radiographic changes(x ray and MRI), and complications were compared between the 2 groups.
RESULTS: ODL showed significant more operative time(155 min Vs 95 min)and more blood loss(438 ml Vs 215 ml)than ACDF.Both ACDF and ODL groups showed significant improvement in Nurick grade from 3.5 and 3.4 preoperatively to 1.85 and 1.95 respectively at last follow up(P<0.05). Both groups significantly improved the JOA (P<0.05)and recovery rate(RR) was similar(63.2% in ACDF group and 64.4% in ODL group) (P<0.05).The cervical motion (on dynamic lateral x-ray)significantly decreasd postoperatively in both groups(P<0.05)while it significantly improved in ODL group at last follow up.Minimal complications were reported in both groups.
CONCLUSIONS: Both ACDF and ODL are effective treatment for multilevel cervical spondylotic myelopathy with no significant difference between the two groups in Nurick grade, JOA score,recovery rate and MRI sagittal canal diameter widening.However, ODL group showed significant better cervical motion at last follow up but unfortunately,longer operative time and more blood loss.