Acta Neurologica Belgica

, Volume 119, Issue 4, pp 585–593 | Cite as

Comparison of the effect of anterior and posterior neurosurgical treatment for cervical spondylotic myelopathy: a clinical outcome

  • B. BourgonjonEmail author
  • J. Duerinck
  • M. Moens
  • J. D’Haens
Original article


Cervical degenerative disease is the most common cause of acquired disability in patients over the age of 50. The incidence of cervical spondylotic myelopathy (CSM) is increasing with aging of the population. Surgical decompression is indicated for severe CSM. There is, however, insufficient evidence to prefer anterior over posterior surgical decompression technique for CSM. Our purpose was to identify groups of patients that would benefit from a chosen surgical approach with a better clinical outcome. We conducted a retrospective analysis of patients operated for CSM between 2007 and 2011. Patients were assessed according to the Nurick grading system. Preoperative and postoperative clinical details and MR imaging were analyzed. Treatment consisted of either anterior cervical discectomy with fusion (ACDF) or laminectomy without fusion. Over a period of 4 years, 90 patients were included. The mean age of patients was 64.5 ± 1.3 years. Of 90 included patients, 42 patients were treated with ACDF and 48 with laminectomy. Mean total Nurick grade recovery rate (NGRR) was 29.6% with 31.2% in ACDF and 27.7% in laminectomy. Mid-sagittal diameter of the cervical canal measured on MRI-T2 increased significantly more with laminectomy (4.4 mm) than ACDF (2.2 mm) (p < 0.001). The presence of preoperative spasticity or quadriparesis or a multilevel compression indicated a higher recovery on the Nurick scale. Surgical treatment of CSM leads to a significant improvement of the functional neurological status of the patient as well as an increase in the diameter of the cervical canal. No significant difference in Nurick recovery was found between ACDF and laminectomy indicating that clinical decision-making in our series was adequate. We were able to demonstrate that even severely disabled patients have a good chance of neurologic recovery after surgical treatment for CSM.


Cervical spondylotic myelopathy ACDF Laminectomy 


Author contributions

The study and manuscript preparation include the following. Conception and design: Bourgonjon, Duerinck. Acquisition of data: Bourgonjon. Analysis and interpretation of data: Bourgonjon, Duerinck. Drafting the article: Bourgonjon, Duerinck, Moens. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Bourgonjon, Duerinck, Moens. We would like to thank Prof. Em. Patrick Haentjens for the statistical analysis and Prof. Em. Patrick Herregodts for helping in conception and design.

Compliance with ethical standard

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or findings specified in this paper.

Supplementary material

13760_2019_1184_MOESM1_ESM.xls (2.1 mb)
Supplementary material 1 (XLS 2160 kb)


  1. 1.
    Brain WR, Northfield D, Wilinson M (1952) The neurological manifestations of cervical spondylosis. Brain 75:187–225CrossRefGoogle Scholar
  2. 2.
    Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100CrossRefGoogle Scholar
  3. 3.
    Benzel EC, Lancon J, Kesterson L, Hadden T (1991) Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 4(3):286–295CrossRefGoogle Scholar
  4. 4.
    Kadanka Z, Bednarík J, Vohánka S, Vlach O, Stejskal L, Chaloupka R et al (2000) Conservative treatment versus surgery in spondylotic cervical myelopathy: a prospective randomised study. Eur Spine J 9:538–544CrossRefGoogle Scholar
  5. 5.
    Matz PG, Holly LT, Mummaneni PV, Anderson PA, Groff MW, Heary RF et al (2009) Anterior cervical surgery for the treatment of cervical degenerative myelopathy. J Neurosurg Spine 11:170–173CrossRefGoogle Scholar
  6. 6.
    Mummaneni PV, Kaiser MG, Matz PG, Anderson PA, Groff MW, Heary RF et al (2009) Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. J Neurosurg Spine 11:130–141CrossRefGoogle Scholar
  7. 7.
    Mumenthaler M, Mattle H (2004) Neurology. George Thieme Verlag, Leipzig, pp 276–290Google Scholar
  8. 8.
    Rajshekhar V, Muliyil J (2007) Patient perceived outcome after central corpectomy for cervical spondylotic myelopathy. Surg Neurol 68:185–190CrossRefGoogle Scholar
  9. 9.
    Fehlings MG, Smith JS, Kopjar B, Arnold PM, Yoon ST, Vaccaro AR et al (2012) Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America cervical spondylotic myelopathy study. J Neurosurg Spine 16:425–432CrossRefGoogle Scholar
  10. 10.
    Kato F, Yukawa Y, Suda K, Yamagata M, Ueta T (2012) Normal morphology, age-related changes and abnormal findings of the cervical spine. Part II: magnetic resonance imaging of over 1200 asymptomatic subjects. Eur Spine J 21:1499–1507CrossRefGoogle Scholar
  11. 11.
    Fehlings MG et al (2012) Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study. J Bone Jt Surg Am 4:1–78Google Scholar
  12. 12.
    Bhatia NN, Geck M, Gottlieb J, Harrison R (2005) Eismont F (2005) Laminoplasty for cervical spondylotic myelopathy in the elderly north american population: minimum of 2 year follow-up: poster #75. Spine J Meet Abstr 7:322–323Google Scholar
  13. 13.
    Ebersold MJ, Pare MC, Quast LM (1995) Surgical treatment for cervical spondylitic myelopathy. J Neurosurg 82:745–751CrossRefGoogle Scholar
  14. 14.
    Edwards CC, Heller JG, Murakami H (2002) Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine 27:1168–1175 (Phila Pa 1976) CrossRefGoogle Scholar
  15. 15.
    Heller JG, Edwards CC, Murakami H, Rodts GE (2001) Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine 26:1330–1336 (Phila Pa 1976) CrossRefGoogle Scholar
  16. 16.
    Kaminsky SB, Clark CR, Traynelis VC (2004) Operative treatment of cervical spondylotic myelopathy and radiculopathy. A comparison of laminectomy and laminoplasty at 5 year average follow-up. Iowa Orthop J 24:95–105PubMedPubMedCentralGoogle Scholar
  17. 17.
    Phillips DG (1973) Surgical treatment of myelopathy with cervical spondylosis. J Neurol Neurosurg Psychiatr 36:879–884CrossRefGoogle Scholar
  18. 18.
    Northover JR, Wild JB, Braybrooke J, Blanco J (2012) The epidemiology of cervical spondylotic myelopathy. Skelet Radiol 41:1543–1546CrossRefGoogle Scholar
  19. 19.
    Hirabayashi K, Watanabe K, Wakano K, Suzuki N, Satomi K, Ishii Y (1983) Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine 8:693–699 (Phila Pa 1976) CrossRefGoogle Scholar
  20. 20.
    Itoh T, Tsuji H (1985) Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine. Spine 10:729–736 (Phila Pa 1976) CrossRefGoogle Scholar
  21. 21.
    Macagno A, Liu S, Marascalchi BJ, Yang S, Boniello AJ, Bendo JA, Lafage VC et al (2015) Perioperative risks associated with cervical spondylotic myelopathy based on surgical treatment strategies. Int J Spine Surg 9:24CrossRefGoogle Scholar
  22. 22.
    Wang T, Tian XM, Liu SK, Wang H, Zhang YZ, Ding WY (2017) Prevalence of complications after surgery in treatment for cervical compressive myelopathy: a meta-analysis for last decade. Med (United States) 96(12):e6421Google Scholar
  23. 23.
    Galasso O, Mariconda M, Iannò B, De Gori M, Gasparini G (2012) Long-term follow-up results of the Cloward procedure for cervical spondylotic myelopathy. Eur Spine J 22:128–134CrossRefGoogle Scholar
  24. 24.
    Revanappa KK, Rajshekhar V (2011) Comparison of Nurick grading system and modified Japanese orthopaedic association scoring system in evaluation of patients with cervical spondylotic myelopathy. Eur Spine J 20:1545–1551CrossRefGoogle Scholar
  25. 25.
    Arnold H, Feldmann U, Missler U (1993) Chronic spondylogenic cervical myelopathy. A critical evaluation of surgical treatment after early and long-term follow-up. Neurosurg Rev 16:105–109CrossRefGoogle Scholar
  26. 26.
    Cunningham MRA, Hershman S, Bendo J (2010) Systematic review of cohort studies comparing surgical treatments for cervical spondylotic myelopathy. Spine 35:537–543 (Phila Pa 1976) CrossRefGoogle Scholar
  27. 27.
    Seng C, Tow BPB, Siddiqui MA, Srivastava A, Wang L, Yew AKS, Yeo W et al (2013) Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. Spine J 13:723–731CrossRefGoogle Scholar
  28. 28.
    Holly LT, Matz PG, Anderson PA, Groff MW, Heary RF, Kaiser MG et al (2009) Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy. J Neurosurg Spine 11:112–118CrossRefGoogle Scholar
  29. 29.
    Tetreault LA, Kopjar B, Vaccaro A, Yoon ST, Arnold PM, Massicotte EM, Fehlings MG (2013) A clinical prediction model to determine outcomes in patients with cervical spondylotic myelopathy undergoing surgical treatment: data from the prospective, multi-center AOSpine North America study. J Bone Jt Surg Am 95:1659–1666CrossRefGoogle Scholar
  30. 30.
    Fehlings MG, Barry S, Kopjar B, Yoon ST, Arnold P, Massicotte EM et al (2013) Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine 38(26):2247–2252CrossRefGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyUZ BrusselBrusselsBelgium
  2. 2.Department of NeurosurgeryUZ BrusselBrusselsBelgium

Personalised recommendations