• Michael G Fehlings, Sean Barry, Branko Kopjar, Sangwook Tim Yoon, Paul Arnold, Eric M Massicotte, Alexander Vaccaro, Darrel S Brodke, Christopher Shaffrey, Justin S Smith, Eric Woodard, Robert J Banco, Jens Chapman, Michael Janssen, Christopher Bono, Rick Sasso, Mark Dekutoski, and Ziya L Gokaslan.
• *University of Toronto, Toronto, Ontario, Canada †University of Washington, Seattle, WA ‡Emory University, Atlanta, GA §University of Kansas, Kansas City, KS ¶Thomas Jefferson University, Philadelphia, PA ‖University of Utah, Salt Lake City, UT **University of Virginia, Charlottesville, VA ††New England Baptist Hospital, Boston, MA ‡‡Boston Spine Group, Newton, MA §§Spine Education and Research Institute, Denver, CO ¶¶Brigham and Woman's Hospital, Boston, MA ‖ ‖Indiana Spine Group, Indianapolis, IN ***The CORE Institute, Phoenix, AZ; and †††John Hopkins University, Baltimore, MD.
• Spine. 2013 Dec 15;38(26):2247-52.

Study DesignA prospective observational multicenter study.ObjectiveTo help solve the debate regarding whether the anterior or posterior surgical approach is optimal for patients with cervical spondylotic myelopathy (CSM).Summary Of Background DataThe optimal surgical approach to treat CSM remains debated with varying opinions favoring anterior versus posterior surgical approaches. We present an analysis of a prospective observational multicenter study examining outcomes of surgical treatment for CSM.MethodsA total of 278 subjects from 12 sites in North America received anterior/posterior or combined surgery at the discretion of the surgeon. This study focused on subjects who had either anterior or posterior surgery (n = 264, follow-up rate, 87%). Outcome measures included the modified Japanese Orthopedic Assessment scale, the Nurick scale, the Neck Disability Index, and the Short-Form 36 (SF-36) Health Survey version 2 Physical and Mental Component Scores.ResultsOne hundred and sixty-nine patients were treated anteriorly and 95 underwent posterior surgery. Anterior surgical cases were younger and had less severe myelopathy as assessed by mJOA and Nurick scores. There were no baseline differences in Neck Disability Index or SF-36 between the anterior and posterior cases. Improvement in the mJOA was significantly lower in the anterior group than posterior group (2.47 vs. 3.62, respectively, P < 0.01), although the groups started at different levels of baseline impairment. The extent of improvement in the Nurick Scale, Neck Disability Index, SF-36 version 2 Physical Component Score, and SF-36 version 2 Mental Component Score did not differ between the groups.ConclusionPatients with CSM show significant improvements in several health-related outcome measures with either anterior or posterior surgery. Importantly, patients treated with anterior techniques were younger, with less severe impairment and more focal pathology. We demonstrate for the first time that, when patient and disease factors are controlled for, anterior and posterior surgical techniques have equivalent efficacy in the treatment of CSM.Level Of Evidence3.

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