Comparison of Outcomes Between Anterior Cervical Decompression and Fusion and Posterior Laminoplasty in the Treatment of 4-Level Cervical Spondylotic Myelopathy

OBJECTIVE: To compare the outcome of anterior cervical decompression and fusion (ACDF) and posterior laminoplasty (LAMP) for treating 4-level cervical spondylotic myelopathy (CSM). METHODS: Data of 80 patients with 4-level CSM treated using ACDF and another 56 cases treated using LAMP were retrospectively analyzed. Radiologic outcomes evaluated by C2-7 Cobb angle and cervical range of motion (ROM) and functional outcomes evaluated by Japanese Orthopaedic Association (JOA) scale score and visual analog scale score for axial pain were compared between the 2 groups. RESULTS: JOA scale score in both groups improved significantly after operation (P < 0.05). There was no significant difference in the JOA scale score improvement rate between the 2 groups (P > 0.05). The C2-7 Cobb angle increased significantly in the ACDF group (P < 0.05) and decreased in the LAMP group (P > 0.05). There was a significant difference in C2-7 Cobb angle improvement between the 2 groups (P < 0.05). Cervical ROM decreased in both groups after operation (P < 0.05), but there was no significant difference in ROM loss ratio between the 2 groups (P > 0.05). Blood loss in the LAMP group was significantly more than in the ACDF group (P < 0.05); however, there was no significant difference in operation time between the 2 groups (P > 0.05). There was no significant difference in the complication rate between the 2 groups (P > 0.05). CONCLUSIONS: Both ACDF and LAMP were effective in the treatment of multilevel CSM. Compared with LAMP, ACDF is less invasive and may be more suitable for elderly patients with poor tolerance of surgery.