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Comparison Between Anterior and Posterior Decompression for Degenerative Cervical Myelopathy With Multilevel
Sang Hun Lee1, Ahmed Sulieman1, Jae Chul Lee2
1Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
Clinical Spine Surgery
|December 31, 2025
Summary
Both anterior and posterior approaches offer similar outcomes for degenerative cervical myelopathy (DCM) with multilevel foraminal stenosis. Clinical results were comparable, though adjacent segment pathology was more common with the anterior approach.
Area of Science:
- Neurosurgery
- Spine Surgery
- Degenerative Cervical Myelopathy
Background:
- Previous studies on anterior vs. posterior approaches for degenerative cervical myelopathy (DCM) show similar neurological outcomes.
- Multilevel DCM often coexists with foraminal stenosis, but outcomes for combined conditions, especially radicular symptoms, are less understood.
Purpose of the Study:
- To compare surgical outcomes of anterior and posterior decompressive procedures for DCM with multilevel foraminal stenosis.
- To evaluate clinical and radiographic parameters, complications, and adjacent segment pathologies in both surgical groups.
Main Methods:
- Retrospective analysis of 96 patients with DCM and multilevel foraminal stenosis (>3 levels).
- Patients underwent either multilevel anterior cervical decompression and fusion (Group A) or laminoplasty with foraminotomies (Group P).
- Outcomes assessed included Nurick grade, pain scores (VAS), disability (NDI), quality of life (SF-36), complications, adjacent segment pathology (CASP, RASP), and need for further surgery.
Main Results:
- Both groups showed significant improvement in clinical parameters from baseline, with no significant difference between anterior and posterior approaches at final follow-up.
- Radiographic adjacent segment pathology (RASP) and clinical adjacent segment pathology (CASP) were significantly higher in the anterior group (42.6% vs. 19.2%).
- Additional procedures were similar between groups, but the reasons differed: CASP in the anterior group and persistent radicular symptoms in the posterior group.
Conclusions:
- Anterior and posterior decompressive surgeries provide reliable and similar outcomes for degenerative cervical myelopathy (DCM) with multilevel foraminal stenosis, addressing both myelopathy and radicular symptoms effectively.
- The primary factors impacting clinical outcomes were the higher incidence of CASP in the anterior group and persistent radicular symptoms in the posterior group.
