Impact of Anterior versus Posterior Reconstruction Techniques on T1 Slope Minus Cervical Lordosis Matching in Patients with Multilevel Cervical Spondylotic Myelopathy.

Abstract

To explore the impact of anterior versus posterior reconstruction techniques on T1 slope (T1S) minus cervical lordosis (CL) matching in patients with multilevel cervical spondylotic myelopathy (CSM). Five hundred ninety-four multilevel CSM patients were enrolled from medical records spanning from 2015 to 2024. The anterior group comprised 305 patients with matching type 157 individuals and mismatching type 148 cases, posterior group included 289 patients with matching type 146 individuals and mismatching type 143 cases. This study retrospectively analyzed perioperative parameters including clinical parameters of Japanese Orthopedic Association score, visual analog scale and Neck Disability Index, and radiologic parameters T1S, CL, C2-7 sagittal vertical axis and T1S-CL. Prior to surgery, there were no significant differences in factors between two groups (P > 0.05) except for blood loss (P < 0.001). Postoperatively, radiological parameters (T1S, CL, C2-7 sagittal vertical axis and T1S-CL) and functional indicators (Japanese Orthopedic Association, Neck Disability Index and visual analog scale) changed significantly (P < 0.001) in anterior and posterior group, whether with T1S-CL matching or mismatching type. In anterior group, T1S-CL changed significantly (P < 0.05) under 20° in both type. While, T1S-CL changed significantly (P < 0.001) under 20° in posterior group with matching type, T1S-CL changed significantly (P < 0.001) above 20° in posterior group with mismatching type. In each group and types, T1S-CL showed positive correlations with T1S and negative correlations (P < 0.001) postoperatively. Anterior reconstruction surgeries can improve and optimize T1S-CL matching, while a T1S-CL mismatching is more likely to occur or deteriorate after posterior surgeries in patients with multilevel CSM.