Skip to main content

Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better?

Publication ,  Journal Article
Chan, AK; Shaffrey, CI; Gottfried, ON; Park, C; Than, KD; Bisson, EF; Bydon, M; Asher, AL; Coric, D; Potts, EA; Foley, KT; Wang, MY; Fu, K-M ...
Published in: J Neurosurg Spine
January 1, 2023

OBJECTIVE: The aim of this study was to determine whether multilevel anterior cervical discectomy and fusion (ACDF) or posterior cervical laminectomy and fusion (PCLF) is superior for patients with cervical spondylotic myelopathy (CSM) and high preoperative neck pain. METHODS: This was a retrospective study of prospectively collected data using the Quality Outcomes Database (QOD) CSM module. Patients who received a subaxial fusion of 3 or 4 segments and had a visual analog scale (VAS) neck pain score of 7 or greater at baseline were included. The 3-, 12-, and 24-month outcomes were compared for patients undergoing ACDF with those undergoing PCLF. RESULTS: Overall, 1141 patients with CSM were included in the database. Of these, 495 (43.4%) presented with severe neck pain (VAS score > 6). After applying inclusion and exclusion criteria, we compared 65 patients (54.6%) undergoing 3- and 4-level ACDF and 54 patients (45.4%) undergoing 3- and 4-level PCLF. Patients undergoing ACDF had worse Neck Disability Index scores at baseline (52.5 ± 15.9 vs 45.9 ± 16.8, p = 0.03) but similar neck pain (p > 0.05). Otherwise, the groups were well matched for the remaining baseline patient-reported outcomes. The rates of 24-month follow-up for ACDF and PCLF were similar (86.2% and 83.3%, respectively). At the 24-month follow-up, both groups demonstrated mean improvements in all outcomes, including neck pain (p < 0.05). In multivariable analyses, there was no significant difference in the degree of neck pain change, rate of neck pain improvement, rate of pain-free achievement, and rate of reaching minimal clinically important difference (MCID) in neck pain between the two groups (adjusted p > 0.05). However, ACDF was associated with a higher 24-month modified Japanese Orthopaedic Association scale (mJOA) score (β = 1.5 [95% CI 0.5-2.6], adjusted p = 0.01), higher EQ-5D score (β = 0.1 [95% CI 0.01-0.2], adjusted p = 0.04), and higher likelihood for return to baseline activities (OR 1.2 [95% CI 1.1-1.4], adjusted p = 0.002). CONCLUSIONS: Severe neck pain is prevalent among patients undergoing surgery for CSM, affecting more than 40% of patients. Both ACDF and PCLF achieved comparable postoperative neck pain improvement 3, 12, and 24 months following 3- or 4-segment surgery for patients with CSM and severe neck pain. However, multilevel ACDF was associated with superior functional status, quality of life, and return to baseline activities at 24 months in multivariable adjusted analyses.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

January 1, 2023

Volume

38

Issue

1

Start / End Page

42 / 55

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spondylosis
  • Spinal Osteophytosis
  • Spinal Fusion
  • Spinal Cord Diseases
  • Retrospective Studies
  • Quality of Life
  • Pain, Postoperative
  • Orthopedics
  • Neck Pain
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chan, A. K., Shaffrey, C. I., Gottfried, O. N., Park, C., Than, K. D., Bisson, E. F., … Mummaneni, P. V. (2023). Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better? J Neurosurg Spine, 38(1), 42–55. https://doi.org/10.3171/2022.6.SPINE22110
Chan, Andrew K., Christopher I. Shaffrey, Oren N. Gottfried, Christine Park, Khoi D. Than, Erica F. Bisson, Mohamad Bydon, et al. “Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better?J Neurosurg Spine 38, no. 1 (January 1, 2023): 42–55. https://doi.org/10.3171/2022.6.SPINE22110.
Chan AK, Shaffrey CI, Gottfried ON, Park C, Than KD, Bisson EF, et al. Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better? J Neurosurg Spine. 2023 Jan 1;38(1):42–55.
Chan, Andrew K., et al. “Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better?J Neurosurg Spine, vol. 38, no. 1, Jan. 2023, pp. 42–55. Pubmed, doi:10.3171/2022.6.SPINE22110.
Chan AK, Shaffrey CI, Gottfried ON, Park C, Than KD, Bisson EF, Bydon M, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu K-M, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Chou D, Haid RW, Mummaneni PV. Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better? J Neurosurg Spine. 2023 Jan 1;38(1):42–55.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

January 1, 2023

Volume

38

Issue

1

Start / End Page

42 / 55

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spondylosis
  • Spinal Osteophytosis
  • Spinal Fusion
  • Spinal Cord Diseases
  • Retrospective Studies
  • Quality of Life
  • Pain, Postoperative
  • Orthopedics
  • Neck Pain