Laminoplasty versus multiple anterior cervical discectomy for cervical spondylotic myelopathy in patients with a lordotic cervical spine

Background
Using anterior or posterior surgery for multilevel cervical spondylotic myelopathy continues to be a subject of considerable debate. Studies comparing the two approaches are limited and few studies focus on anterior cervical discectomy and fusion (ACDF) as against open-door laminoplasty (ODL).
Study design
This investigation was designed as a prospective study.
Objective
The aim of the study was to compare the clinical outcomes, radiographic changes, and complications of patients with multilevel cervical spondylotic myelopathy who underwent ACDF and ODL in the lordotic cervical spine.
Patients and methods
We evaluated 40 patients (20 patients in the ACDF group and 20 patients in the ODL group) at our institution from September 2005 to December 2008. They were followed up for a minimum of 2 years. The clinical outcomes [Nurick grade and Japanese Orthopaedic Association (JOA) score], radiographic changes (radiograph and MRI), and complications were compared between the two groups.
Results
ODL showed significantly longer operative time (155 vs. 95 min) and more blood loss (438 vs. 215 ml) compared with ACDF. Both the ACDF and ODL groups showed significant improvement in Nurick grade from 3.5 and 3.4 preoperatively to 1.85 and 1.95, respectively, at last followup (<0.05). Both groups showed significant improvement in the JOA score (<0.05), and recovery rate was similar (63.2% in the ACDF group and 64.4% in the ODL group) (>0.05). Cervical motion (on dynamic lateral radiograph) decreased significantly postoperatively in both groups (<0.05) but was seen to have significantly improved in the ODL group at last follow-up. Minimal complications were reported in both groups.
Conclusion
Both ACDF and ODL are effective treatment modalities for multilevel cervical spondylotic myelopathy with no significant difference between the two groups in Nurick grade, JOA score, recovery rate, and MRI sagittal canal diameter widening. However, the ODL group showed significantly better cervical motion at last follow-up but, unfortunately, longer operative time and greater blood loss.