Anterior vs Posterior Surgery for Patients With Degenerative Cervical Myelopathy: An Observational Study From the Canadian Spine Outcomes and Research Network

Nathan Evaniew; Christopher S Bailey; Y Raja Rampersaud; W Bradley Jacobs; Philippe Phan; Andrew Nataraj; David W Cadotte; Michael H Weber; Kenneth C Thomas; Neil Manson; Najmedden Attabib; Jerome Paquet; Sean D Christie; Jefferson R Wilson; Hamilton Hall; Charles G Fisher; Greg McIntosh; Nicolas Dea

doi:10.1227/neu.0000000000002842

Anterior vs Posterior Surgery for Patients With Degenerative Cervical Myelopathy: An Observational Study From the Canadian Spine Outcomes and Research Network

Neurosurgery. 2024 Feb 2. doi: 10.1227/neu.0000000000002842. Online ahead of print.

Authors

Nathan Evaniew¹, Christopher S Bailey², Y Raja Rampersaud³, W Bradley Jacobs¹, Philippe Phan⁴, Andrew Nataraj⁵, David W Cadotte¹, Michael H Weber⁶, Kenneth C Thomas¹, Neil Manson⁷, Najmedden Attabib⁷, Jerome Paquet⁸, Sean D Christie⁹, Jefferson R Wilson³, Hamilton Hall³, Charles G Fisher¹⁰, Greg McIntosh¹¹, Nicolas Dea¹⁰

Affiliations

¹ University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada.
² London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, Schulich School of Medicine, Western University, London, Ontario, Canada.
³ Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁴ Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.
⁶ Division of Orthopaedics, McGill University, Montreal, Quebec, Canada.
⁷ Canada East Spine Centre, Saint John, New Brunswick, Canada.
⁸ Department of Orthopaedics, Centre Hospitalier, Universitaire de Quebec, Quebec, Quebec, Canada.
⁹ Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁰ Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada.
¹¹ Canadian Spine Society, Toronto, Ontario, Canada.

PMID: 38305343
DOI: 10.1227/neu.0000000000002842

Abstract

Background and objectives: The advantages and disadvantages of anterior vs posterior surgical approaches for patients with progressive degenerative cervical myelopathy (DCM) remain uncertain. Our primary objective was to evaluate patient-reported disability at 1 year after surgery. Our secondary objectives were to evaluate differences in patient profiles selected for each approach in routine clinical practice and to compare neurological function, neck and arm pain, health-related quality of life, adverse events, and rates of reoperations.

Methods: We analyzed data from patients with DCM who were enrolled in an ongoing multicenter prospective observational cohort study. We controlled for differences in baseline characteristics and numbers of spinal levels treated using multivariable logistic regression. Adverse events were collected according to the Spinal Adverse Events Severity protocol.

Results: Among 559 patients, 261 (47%) underwent anterior surgery while 298 (53%) underwent posterior surgery. Patients treated posteriorly had significantly worse DCM severity and a greater number of vertebral levels involved. After adjusting for confounders, there was no significant difference between approaches for odds of achieving the minimum clinically important difference for the Neck Disability Index (odds ratio 1.23, 95% CI 0.82 to 1.86, P = .31). There was also no significant difference for change in modified Japanese Orthopedic Association scores, and differences in neck and arm pain and health-related quality of life did not exceed minimum clinically important differences. Patients treated anteriorly experienced greater rates of dysphagia, whereas patients treated posteriorly experienced greater rates of wound complications, neurological complications, and reoperations.

Conclusion: Patients selected for posterior surgery had worse DCM and a greater number of vertebral levels involved. Despite this, anterior and posterior surgeries were associated with similar improvements in disability, neurological function, pain, and quality of life. Anterior surgery had a more favorable profile of adverse events, which suggests it might be a preferred option when feasible.