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

BACKGROUND: 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. METHODS: 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. RESULTS: In total, 24 patients underwent ACDF with ROIC 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 degrees in the ACDF group and 4.8 degrees in the LMP group (P = 0.01). No significant differences were found between complication rates. CONCLUSIONS: 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.