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Effectiveness of 3 Surgical Decompression Strategies for Treatment of Multilevel Cervical Myelopathy in 3 Spinal Centers in China: A Retrospective Study

Wen, Shi-Feng, MD*,†; Wong, Irene Oi-Ling, PHD; Long, Mei-Jing, Mphil; Li, Ju-Geng, MD§; Li, Xiao-Feng, MD; Guo, Dong-Ming, MD*; Xu, Zhong-He, MD*; Yin, Qing-Shui, MD

doi: 10.1097/BRS.0b013e31824ff9bc
Cervical Spine
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Study Design. Retrospective multicenter study.

Objective. To compare clinical outcomes and surgical-related adverse events in patients with multilevel cervical myelopathy (MCM) undergoing simple anterior, simple posterior, or 1-stage posterior-anterior surgical decompression strategies.

Summary of Background Data. Simple anterior, simple posterior, and 1-stage posterior-anterior surgical decompression strategies have been advocated for MCM treatment in both Western and Chinese populations. However, there is limited evidence on whether 1-stage posterior-anterior strategy may offer equal or more advantages than the other 2 strategies for patients with MCM.

Methods. A retrospective review of medical records was conducted for 255 patients with MCM who had undergone surgical decompression in 3 Chinese spinal centers from 1999 to 2010. Neurological status, perioperative variables, and surgical complications were assessed. Multiple linear regression was used to evaluate factors associated with the outcomes of each strategy.

Results. Analyses were conducted on a total of 229 patients with MCM undergoing surgical decompression via 1-stage posterior-anterior (68 patients), simple anterior (102 patients), and simple posterior approaches (59 patients). One-stage posterior-anterior approach had the highest Japanese Orthopaedic Association recovery rate after adjusted for age and sex (adjusted mean ± SD: 50.0 ± 3.2, P < 0.001) and additionally adjusted for smoking, duration from onset of symptoms to surgery, comorbidities, preoperative Japanese Orthopaedic Association score, Ishihara's curvature index and Pavlov ratio, operative blood loss, operating time, anterior operated disc levels, and posterior operated levels (adjusted mean ± SD: 51.6 ± 11.6, P < 0.01). Anterior approach had the largest difference between the pre- and postoperative Ishihara's curvature indexes after adjusted for age and sex (adjusted mean ± SD: 5.3 ± 1.0, P < 0.01) and after multivariable adjustment (adjusted mean ± SD: 6.5 ± 2.8, P = 0.003).

Conclusion. One-stage posterior-anterior strategy can be a reliable and effective treatment strategy for MCM in a subgroup of patients with anterior and posterior compression on spinal cord simultaneously.

The optimal procedure for the surgical treatment of MCM remains controversial. Based on our findings, 1-stage anterior-posterior surgical strategy would achieve better chance of neurological recovery which enhanced complete neural decompression and restoration of sagittal lordotic alignment compared to simple anterior or simple posterior surgery methods.

*Department of Spine Surgery, The First Municipal People's Hospital of Guangzhou, Affiliated Hospital to The Guangzhou Medical University, People's Republic of China

The Southern Medical University, Guangzhou, People's Republic of China

School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

§Department of Orthopedics, The Second Affiliated Hospital to Guangzhou Medical University, Guangzhou, People's Republic of China

Department of Orthopedics, The First Affiliated Hospital to Nanchang University, Jiangxi province, People's Republic of China

Department of Orthopedics, Liuhuaqiao Hospital, Guangzhou, People's Republic of China.

Address correspondence and reprint requests to Shi-Feng Wen, MD, Department of Orthopedics, The First Municipal People's Hospital of Guangzhou, 1st Pan Fu Rd., Guangzhou 510180, People's Republic of China; E-mail: pjhkone@hotmail.com

Acknowledgment date: September 1, 2011. First revision date: December 8, 2011. Second revision date: February 8, 2012; Acceptance date: February 13, 2012.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.