Review Question - QID 5609

Surgical decompression of cervical myelopathy via an anterior procedure has lower reported blood loss compared to a posterior procedure.

Cervical myelopathy has a progressive course and therefore if there is evidence of functional impairment surgical decompression is indicated. Either an anterior decompression or posterior decompression can be used depending on a variety of factors including number of levels involved and sagittal alignment of the cervical spine. In general, a posterior approach is used when three or more levels are involved and the spine is in neutral or lordotic alignment.

Fehlings et al. did a prospective study on the risks of complications associated with surgical treatment of cervical myelopathy. They found that combined anterior and posterior procedures had a significantly higher rate of complication than either anterior-only or posterior-only procedures. Posterior procedures had a higher rate of wound infections compared to anterior. They found no statistical difference in the over-all complication rate, incidence of C5 radiculopathy, or dysphagia between an anterior-only or posterior-only procedure.

Fehlings et al. did a prospective study on outcomes following surgical treatment of cervical myelopathy. At one year follow-up they found a significant improvement in mJOA score, Nurick grade, NDI score, and all SF-36v2 dimensions. With the exception of mJOA scores, these improvements were not statistically related to severity of disease.

Liu et al. performed a meta-analysis of outcomes following surgical decompression of cervical myelopathy. They found outcomes following anterior procedures were better than those for posterior procedures when there were less than 3 affected levels. With 3 or greater levels, no statistical difference in outcomes could be found between the two approaches. They note none of their reviewed publications represent high-quality prospective randomized trials.

Figure A is a sagittal MR image of the cervical spine showing multi-level degenerative disease with cord compression consistent with cervical myelopathy.

Incorrect Answers:
Answer 1: Incidence of wound infection was found to be higher in patients following a posterior procedure.
Answer 2: No statistically significant difference was found in the incidence of C5 radiculopathy between the anterior or posterior procedures.
Answer 3: No statistically significant difference was found in the over-all complication rate between the anterior or posterior procedures.
Answer 5: No statistically significant difference was found in the incidence of C7 radiculopathy between the anterior or posterior procedures.