Combined Anterior-Posterior Decompression and Fusion for Cervical Spondylotic Myelopathy

We conducted a study to evaluate the operative details, perioperative complications, and short-term outcomes associated with combined anterior-posterior decompression and fusion (CAPDF) for treating cervical spondylotic myelopathy (CSM). We retrospectively reviewed the charts of 21 patients who underwent CAPDF at our institution. Pertinent information, including demographics, surgery indication, perioperative complications, operative time, levels fused (and number of levels fused) anteriorly and posteriorly, estimated blood loss, and length of stay, was gathered. Outpatient follow-up data were available for 20 of the 21 patients, and postoperative neurologic status was evaluated with Nurick grades as well as by subjective means. Mean age was 62.1 years (range, 44-79 years). Of the 21 patients, 9 were female, and 12 were male. Before surgery, all patients had a diagnosis of CSM of varying degree. Mean number of levels fused was 2 (range, 1-3) anteriorly and 3 (range, 1-4) posteriorly. Mean operative time, which included patient repositioning, was 4 hours 55 minutes (range, 3:04-6:22). Mean estimated blood loss was 131 mL (range, 55-278 mL), and mean length of stay was 5 days (range, 2-10 days). The most commonly encountered complication was dysphagia (28.6%, 6/21). Neither neurologic instability nor mortality was observed after surgery. Neurologic status was subjectively improved for 19 patients and unimproved for 1 patient; no patient's neurologic status was worse. Mean Nurick grade was 1.9 before surgery and 1.1 after surgery (mean difference, 0.80; P < .001), at a mean follow-up of 96 days (range, 51-149 days). When indicated, CAPDF is an efficient and effective treatment for CSM. This study found the procedure to be associated with minor complications, no new neurologic deficits, and high levels of neurologic improvement. The positive short-term outcomes and low rate of long-term complications in our study, combined with data from previous comparative studies, suggest that same-day surgery is superior to staged surgery.