Anterior-only decompression insufficient in concentric stenosis in degenerative cervical myelopathy

The compression of the spinal cord can result in degenerative cervical myelopathy (DCM), a condition characterized by progressive neurological dysfunction.This study examines clinical outcomes after anterior decompression and predictors of secondary posterior decompression after initial anterior surgery.

We conducted a retrospective review of 94 consecutive patients who underwent anterior-only cervical decompression in DCM. Preoperative variables (demographics, neurological and clinical status, spine anatomy) were entered into a multivariate logistic regression to determine associations with secondary posterior decompression. Neurologic function was assessed by the JOA score.

Nine of 94 patients (9.6 %) underwent secondary posterior decompression for persistent myelopathic symptoms, of which all presented with a concentric spinal canal stenosis. In multivariate analysis, higher ASA score (p = 0.042), concentric stenosis (p = 0.008) and osteoporosis (p = 0.044) were independently associated with increased revision risk. At six weeks, the anterior-only cohort achieved a mean JOA score of 15.44, compared to 12.60 in those undergoing revision (measured pre-revision).

Concentric stenosis morphology, compromised bone quality, and elevated ASA status independently predict failure of anterior-only decompression. In patients exhibiting this high-risk profile, a primary combined anterior-posterior approach should be strongly considered to ensure circumferential decompression and optimize early neurologic recovery.