Comparative Study Between Anterior Cervical Discectomy and Fusion with ROI-C Cage and Laminoplasty for Multilevel Cervical Spondylotic Myelopathy without Spinal Stenosis.

Abstract

Selection of anterior versus posterior surgery for multilevel (≥3) cervical spondylotic myelopathy (MCSM) continues to be controversial. A comparison between anterior cervical discectomy and fusion (ACDF) with ROI-C cage and laminoplasty was made to determine the better treatment for MCSM. Between 2012 and 2017, 57 patients received either ACDF with ROI-C or laminoplasty (LMP) treatment. Clinical and radiologic outcomes between the 2 groups were compared. In total, 24 patients underwent ACDF with ROI-C cage (ACDF group) and 33 patients underwent LMP (LMP group). They were studied with a median follow-up of 22 months. Less operative blood loss (136.7 ± 60.8 vs. 316.7 ± 139.6 mL, P < 0.001) and a shorter hospital stay (7.8 ± 1.6 vs. 9.9 ± 3.3 days, P < 0.01) were notable for ACDF. The Japanese Orthopedic Association score showed that ACDF and LMP improved similarly (recovery rate, 55.3 ± 19.2% vs. 58.9 ± 18.1%, P > 0.05). Preoperative occupying rate and JOA score significantly affected the operation result (P < 0.01). The cervical lordosis, segmental cervical lordosis, and T1 slope were all larger in the ACDF group. The cervical range of motion decreased 10.6° in the ACDF group and 4.8° in the LMP group (P = 0.01). No significant differences were found between complication rates. ACDF with ROI-C cage has a similar clinical efficacy to LMP for patients with MCSM. There was less blood loss, shorter hospital stays, and improved sagittal balance when ACDF was used. However, a greater decrease in range of motion was observed after ACDF. Preoperative occupying ratio and Japanese Orthopaedic Association score are potential risk factors for different outcomes.