A comparative study of surgical outcomes between anterior cervical discectomy with fusion and selective laminoplasty for cervical spondylotic myelopathy.
J Orthop Sci
; 27(6): 1228-1233, 2022 Nov.
Article
em En
| MEDLINE
| ID: mdl-34579989
ABSTRACT
BACKGROUND:
Few studies have directly compared anterior and posterior surgical approaches in cervical spondylotic myelopathy (CSM) patients with short-segment disease. We aimed to examine and compare surgical outcomes of anterior cervical discectomy with fusion (ACDF) and selective laminoplasty (S-LAMP) in CSM patients with 1- or 2-level disease.METHODS:
Forty-six patients, who received surgeries for CSM, were prospectively investigated; 24 underwent ACDF and 22 underwent S-LAMP. Average follow-up was 3.5 years. The following pre- and postoperative radiographic measurements were recorded (1) C2-7 angle, (2) local angle (lordotic Cobb angle at operative level), (3) cervical sagittal vertical axis (SVA) (center of gravity of the head-C7 SVA), and (4) C7 slope. Outcomes were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (C-JOA score), neck pain visual analog scale, and neck disability index (NDI).RESULTS:
There were no significant differences in patient demographics between the two groups. Postoperatively, C2-7 angle, local angle, cervical SVA, C7 slope, C-JOA score, and neck pain and NDI scores were not significantly different between the two groups; however, the recovery rate of the C-JOA score was superior in the ACDF group (57.5%) compared to the S-LAMP group (42.1%). The recovery rate of the C-JOA score in the local lordosis subgroup (local angle ≥ 0°) showed no significant difference between the two surgical groups. However, in the local kyphosis subgroup (local angle < 0°), C-JOA score recovery rate was worse after S-LAMP (20.4%) than ACDF (57.9%); local angle also worsened postoperatively after S-LAMP.CONCLUSIONS:
In patients with local lordosis at the segments of cervical spondylosis and spinal cord compression, S-LAMP showed equivalent surgical outcomes (neurological recovery, neck pain and NDI scores, and cervical alignment) to ACDF. However, in patients with local kyphosis, S-LAMP worsened the kyphosis and resulted in worse neurological recovery.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doenças da Medula Espinal
/
Fusão Vertebral
/
Doenças do Desenvolvimento Ósseo
/
Espondilose
/
Laminoplastia
/
Cifose
/
Lordose
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
J Orthop Sci
Assunto da revista:
ORTOPEDIA
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Japão