多椎間孔狭窄を伴う変性頸椎症性脊髄症に対する前方および後方除圧術の比較
Sang Hun Lee1, Ahmed Sulieman1, Jae Chul Lee2
1Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
Summary Of Background Data:
Previous studies comparing the anterior versus posterior approach for the treatment of degenerative cervical myelopathy (DCM) report similar neurological outcomes. Although multilevel DCM is frequently combined with foraminal stenosis, previous studies have analyzed the outcomes of myelopathy without specifically addressing the outcomes of combined radicular symptoms.
Objective:
To compare the outcomes following anterior and posterior decompressive procedures for DCM combined with multilevel foraminal stenosis.
Study Design:
A retrospective study.
Methods:
A cohort of patients with DCM with multilevel foraminal stenosis (>3 levels) who underwent decompression was analyzed. In the anterior group (group A), multilevel anterior cervical decompression and fusion were performed, and the posterior group (group P) consisted of laminoplasty with foraminotomies. Nurick grade, visual analogue scale (VAS) of neck and arm pain, neck disability index (NDI), short-form 36 (SF-36), complications, clinical adjacent segment pathologies (CASP), and additional operations performed were analyzed. C2-7 angle and range of motion, and Kellgren grade of radiographic adjacent segment pathology (RASP) were evaluated.
Results:
A total of 96 patients were enrolled (M:F=53:43, mean age 60.8 y, A: P=54:42, mean 36.6 mo follow-up). All clinical parameters showed significant improvement from preoperative neurological status without significant difference between the 2 groups at the final follow-up. Both RASP grade and incidence of CASP were higher in the anterior group (A: 42.6% vs. P: 19.2%, P=0.014). The incidence of additional procedures was similar (A: 9.3% vs. P: 16.7%, P=0.276); however, the etiology was mainly CASP in the anterior group (4-5 cases) and persistent radicular symptoms in the posterior group (6-7 cases).
Conclusions:
Anterior and posterior decompressive surgeries are reliable for the surgical treatment of DCM with multilevel foraminal stenosis and showed similar outcomes for both myelopathy and upper extremity radicular symptoms. The major etiology compromising the clinical outcome was a higher incidence of CASP in the anterior group and persistent or recurrent upper extremity radicular symptoms in the posterior group.
