Spine (Phila Pa 1976). 2023 Jan 30. doi: 10.1097/BRS.0000000000004586. Online ahead of print.
ABSTRACT
STUDY DESIGN: Retrospective Cohort.
OBJECTIVE: To compare health related quality of life (HRQoL) outcomes between approach techniques for the treatment of multilevel degenerative cervical myelopathy (DCM).
SUMMARY OF BACKGROUND DATA: Both anterior and posterior approaches for the surgical treatment of cervical myelopathy are successful techniques in the treatment of myelopathy. However, the optimal treatment has yet to be determined, especially for multilevel disease, as the different approaches have separate complication profiles and potentially different impacts on HRQoL metrics.
METHODS: Retrospective review of a prospectively managed single institution database of patient reported outcome measures following three- and four-level anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) for DCM. The electronic medical record was reviewed for patient baseline characteristics and surgical outcomes while preoperative radiographs were analyzed for baseline cervical lordosis and sagittal balance. Univariate and multivariate statistical analyses were performed to compare the two groups.
RESULTS: We identified 153 patients treated by ACDF and 43 patients treated by PCDF. Patients in the ACDF cohort were younger (60.1±9.8 vs. 65.8±6.9 y, P<0.001), had a lower overall comorbidity burden (CCI: 2.25±1.61 vs. 3.07±1.64, P=0.002), and were more likely to have a three-level fusion (79.7% vs. 30.2%, P<0.001), myeloradiculopathy (42.5% vs. 23.3%, P=0.034), and cervical kyphosis (25.7% vs. 7.69%, P=0.027). Patients undergoing an ACDF had significantly more improvement in their neck disability index (NDI) after surgery (-14.28 vs. -3.02, P=0.001), and this relationship was maintained on multivariate analysis with PCDF being independently associated with a worse NDI (+8.83, P=0.025). Patients undergoing an ACDF also experienced more improvement in visual analog score neck pain after surgery (-2.94 vs. -1.47, P=0.025) by univariate analysis.
CONCLUSION: Patients receiving an ACDF for multilevel DCM may experience a HRQoL improvement compared to those receiving a PCDF.
PMID:36716386 | DOI:10.1097/BRS.0000000000004586
