Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy

Outcomes of the prospective multicenter AOSpine north America CSM study in 264 patients

Michael G. Fehlings, Sean Barry, Branko Kopjar, Sangwook Tim Yoon, Paul Arnold, Eric M. Massicotte, Alexander Vaccaro, Darrel S. Brodke, Christopher Shaffrey, Justin S. Smith, Eric Woodard, Robert J. Banco, Jens Chapman, Michael Janssen, Christopher Bono, Rick Sasso, Mark Dekutoski, Ziya L. Gokaslan

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN.: A prospective observational multicenter study. OBJECTIVE.: To help solve the debate regarding whether the anterior or posterior surgical approach is optimal for patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA.: The optimal surgical approach to treat CSM remains debated with varying opinions favoring anterior versus posterior surgical approaches. We present an analysis of a prospective observational multicenter study examining outcomes of surgical treatment for CSM. METHODS.: A total of 278 subjects from 12 sites in North America received anterior/posterior or combined surgery at the discretion of the surgeon. This study focused on subjects who had either anterior or posterior surgery (n = 264, follow-up rate, 87%). Outcome measures included the modified Japanese Orthopedic Assessment scale, the Nurick scale, the Neck Disability Index, and the Short-Form 36 (SF-36) Health Survey version 2 Physical and Mental Component Scores. RESULTS.: One hundred and sixty-nine patients were treated anteriorly and 95 underwent posterior surgery. Anterior surgical cases were younger and had less severe myelopathy as assessed by mJOA and Nurick scores. There were no baseline differences in Neck Disability Index or SF-36 between the anterior and posterior cases. Improvement in the mJOA was significantly lower in the anterior group than posterior group (2.47 vs. 3.62, respectively, P <0.01), although the groups started at different levels of baseline impairment. The extent of improvement in the Nurick Scale, Neck Disability Index, SF-36 version 2 Physical Component Score, and SF-36 version 2 Mental Component Score did not differ between the groups. CONCLUSION.: Patients with CSM show significant improvements in several health-related outcome measures with either anterior or posterior surgery. Importantly, patients treated with anterior techniques were younger, with less severe impairment and more focal pathology. We demonstrate for the first time that, when patient and disease factors are controlled for, anterior and posterior surgical techniques have equivalent efficacy in the treatment of CSM.

Original languageEnglish (US)
Pages (from-to)2247-2252
Number of pages6
JournalSpine
Volume38
Issue number26
DOIs
StatePublished - Dec 15 2013

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Spinal Cord Diseases
North America
Neck
Multicenter Studies
Observational Studies
Outcome Assessment (Health Care)
Health Surveys
Orthopedics
Pathology
Health

Keywords

  • cervical spondylotic myelopathy
  • CSM
  • multicenter trial
  • surgery
  • surgical outcomes

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy : Outcomes of the prospective multicenter AOSpine north America CSM study in 264 patients. / Fehlings, Michael G.; Barry, Sean; Kopjar, Branko; Yoon, Sangwook Tim; Arnold, Paul; Massicotte, Eric M.; Vaccaro, Alexander; Brodke, Darrel S.; Shaffrey, Christopher; Smith, Justin S.; Woodard, Eric; Banco, Robert J.; Chapman, Jens; Janssen, Michael; Bono, Christopher; Sasso, Rick; Dekutoski, Mark; Gokaslan, Ziya L.

In: Spine, Vol. 38, No. 26, 15.12.2013, p. 2247-2252.

Research output: Contribution to journalArticle

Fehlings, MG, Barry, S, Kopjar, B, Yoon, ST, Arnold, P, Massicotte, EM, Vaccaro, A, Brodke, DS, Shaffrey, C, Smith, JS, Woodard, E, Banco, RJ, Chapman, J, Janssen, M, Bono, C, Sasso, R, Dekutoski, M & Gokaslan, ZL 2013, 'Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: Outcomes of the prospective multicenter AOSpine north America CSM study in 264 patients', Spine, vol. 38, no. 26, pp. 2247-2252. https://doi.org/10.1097/BRS.0000000000000047
Fehlings, Michael G. ; Barry, Sean ; Kopjar, Branko ; Yoon, Sangwook Tim ; Arnold, Paul ; Massicotte, Eric M. ; Vaccaro, Alexander ; Brodke, Darrel S. ; Shaffrey, Christopher ; Smith, Justin S. ; Woodard, Eric ; Banco, Robert J. ; Chapman, Jens ; Janssen, Michael ; Bono, Christopher ; Sasso, Rick ; Dekutoski, Mark ; Gokaslan, Ziya L. / Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy : Outcomes of the prospective multicenter AOSpine north America CSM study in 264 patients. In: Spine. 2013 ; Vol. 38, No. 26. pp. 2247-2252.
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abstract = "STUDY DESIGN.: A prospective observational multicenter study. OBJECTIVE.: To help solve the debate regarding whether the anterior or posterior surgical approach is optimal for patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA.: The optimal surgical approach to treat CSM remains debated with varying opinions favoring anterior versus posterior surgical approaches. We present an analysis of a prospective observational multicenter study examining outcomes of surgical treatment for CSM. METHODS.: A total of 278 subjects from 12 sites in North America received anterior/posterior or combined surgery at the discretion of the surgeon. This study focused on subjects who had either anterior or posterior surgery (n = 264, follow-up rate, 87{\%}). Outcome measures included the modified Japanese Orthopedic Assessment scale, the Nurick scale, the Neck Disability Index, and the Short-Form 36 (SF-36) Health Survey version 2 Physical and Mental Component Scores. RESULTS.: One hundred and sixty-nine patients were treated anteriorly and 95 underwent posterior surgery. Anterior surgical cases were younger and had less severe myelopathy as assessed by mJOA and Nurick scores. There were no baseline differences in Neck Disability Index or SF-36 between the anterior and posterior cases. Improvement in the mJOA was significantly lower in the anterior group than posterior group (2.47 vs. 3.62, respectively, P <0.01), although the groups started at different levels of baseline impairment. The extent of improvement in the Nurick Scale, Neck Disability Index, SF-36 version 2 Physical Component Score, and SF-36 version 2 Mental Component Score did not differ between the groups. CONCLUSION.: Patients with CSM show significant improvements in several health-related outcome measures with either anterior or posterior surgery. Importantly, patients treated with anterior techniques were younger, with less severe impairment and more focal pathology. We demonstrate for the first time that, when patient and disease factors are controlled for, anterior and posterior surgical techniques have equivalent efficacy in the treatment of CSM.",
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AU - Barry, Sean

AU - Kopjar, Branko

AU - Yoon, Sangwook Tim

AU - Arnold, Paul

AU - Massicotte, Eric M.

AU - Vaccaro, Alexander

AU - Brodke, Darrel S.

AU - Shaffrey, Christopher

AU - Smith, Justin S.

AU - Woodard, Eric

AU - Banco, Robert J.

AU - Chapman, Jens

AU - Janssen, Michael

AU - Bono, Christopher

AU - Sasso, Rick

AU - Dekutoski, Mark

AU - Gokaslan, Ziya L.

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N2 - STUDY DESIGN.: A prospective observational multicenter study. OBJECTIVE.: To help solve the debate regarding whether the anterior or posterior surgical approach is optimal for patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA.: The optimal surgical approach to treat CSM remains debated with varying opinions favoring anterior versus posterior surgical approaches. We present an analysis of a prospective observational multicenter study examining outcomes of surgical treatment for CSM. METHODS.: A total of 278 subjects from 12 sites in North America received anterior/posterior or combined surgery at the discretion of the surgeon. This study focused on subjects who had either anterior or posterior surgery (n = 264, follow-up rate, 87%). Outcome measures included the modified Japanese Orthopedic Assessment scale, the Nurick scale, the Neck Disability Index, and the Short-Form 36 (SF-36) Health Survey version 2 Physical and Mental Component Scores. RESULTS.: One hundred and sixty-nine patients were treated anteriorly and 95 underwent posterior surgery. Anterior surgical cases were younger and had less severe myelopathy as assessed by mJOA and Nurick scores. There were no baseline differences in Neck Disability Index or SF-36 between the anterior and posterior cases. Improvement in the mJOA was significantly lower in the anterior group than posterior group (2.47 vs. 3.62, respectively, P <0.01), although the groups started at different levels of baseline impairment. The extent of improvement in the Nurick Scale, Neck Disability Index, SF-36 version 2 Physical Component Score, and SF-36 version 2 Mental Component Score did not differ between the groups. CONCLUSION.: Patients with CSM show significant improvements in several health-related outcome measures with either anterior or posterior surgery. Importantly, patients treated with anterior techniques were younger, with less severe impairment and more focal pathology. We demonstrate for the first time that, when patient and disease factors are controlled for, anterior and posterior surgical techniques have equivalent efficacy in the treatment of CSM.

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