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Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients.

Publication ,  Journal Article
Fehlings, MG; Barry, S; Kopjar, B; Yoon, ST; Arnold, P; Massicotte, EM; Vaccaro, A; Brodke, DS; Shaffrey, C; Smith, JS; Woodard, E; Banco, RJ ...
Published in: Spine (Phila Pa 1976)
December 15, 2013

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. LEVEL OF EVIDENCE: 3.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

December 15, 2013

Volume

38

Issue

26

Start / End Page

2247 / 2252

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surveys and Questionnaires
  • Spondylosis
  • Spinal Fusion
  • Spinal Cord Diseases
  • Prospective Studies
  • Orthopedics
  • Observational Studies as Topic
  • North America
  • Middle Aged
 

Citation

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Fehlings, M. G., Barry, S., Kopjar, B., Yoon, S. T., Arnold, P., Massicotte, E. M., … Gokaslan, Z. L. (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 (Phila Pa 1976), 38(26), 2247–2252. https://doi.org/10.1097/BRS.0000000000000047
Fehlings, Michael G., Sean Barry, Branko Kopjar, Sangwook Tim Yoon, Paul Arnold, Eric M. Massicotte, Alexander Vaccaro, et al. “Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients.Spine (Phila Pa 1976) 38, no. 26 (December 15, 2013): 2247–52. https://doi.org/10.1097/BRS.0000000000000047.
Fehlings MG, Barry S, Kopjar B, Yoon ST, Arnold P, Massicotte EM, et al. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine (Phila Pa 1976). 2013 Dec 15;38(26):2247–52.
Fehlings, Michael G., et al. “Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients.Spine (Phila Pa 1976), vol. 38, no. 26, Dec. 2013, pp. 2247–52. Pubmed, doi:10.1097/BRS.0000000000000047.
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. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine (Phila Pa 1976). 2013 Dec 15;38(26):2247–2252.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

December 15, 2013

Volume

38

Issue

26

Start / End Page

2247 / 2252

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surveys and Questionnaires
  • Spondylosis
  • Spinal Fusion
  • Spinal Cord Diseases
  • Prospective Studies
  • Orthopedics
  • Observational Studies as Topic
  • North America
  • Middle Aged