Indications and Outcomes for Contemporaneous Anteroposterior Surgery in Cervical Stenosis and Myelopathy: Single Center Experience.

Abstract

Anterior or posterior approaches have been shown to be effective in the treatment of cervical stenosis and myelopathy (CSM). There exists, however, a group of patients in whom both the anterior and posterior approaches are necessary to treat the stenosis and deformity. To better identify the indications and outcomes of the contemporaneous anterior + posterior approaches (CAP), we retrospectively reviewed the records of patients who have been treated with this method. Between 2006 and 2018, 37 patients were treated with CAP for kyphosis, stenosis, and subluxation, with a median follow-up of 20 months (range: 5-112 months). We examined their radiographic metrics, health-related outcomes, and complications. The indication for CAP was severe kyphosis in 12 cases, severe stenosis in 9, and subluxation in 7. Proximal junctional kyphosis was the indication in 4 cases, failure of instrumentation with kyphosis in 3 cases, and adjacent segment degeneration in 2. Kyphosis was corrected in all. Nine patients suffered a total of 14 complications. Six patients developed dysphagia, 2 developed spinal fluid leaks, 1 meningitis, 2 wound dehiscence, and 1 C5 palsy. None were life-threatening and all resolved with appropriate management. The CAP approach, undertaken in cases of CSM associated with severe kyphosis, stenosis, and subluxation, led to a significant correction in kyphosis. There was total of 14 complications, comparable to previously published reports.