Single- and multi-level anterior decompression and fusion for cervical spondylotic myelopathy--a long term follow-up with a minimum of 5 years

Abstract

Objective: Cervical spondylotic myelopathy (CSM) is a common disease leading to significant neurological disability. We compared patients suffering from a single- and a multi-level pathology to analyze the influence of the natural course of the disease on the long-term outcome after surgery.

Methods: We analyzed the records of 52 patients with CSM after surgery. The neurological status of the patients was assessed by the modified Japanese Orthopaedic Association Scale (mJOAS). X-rays were conducted before and after surgery.

Results: 52 patients were treated by a single-level (n=27) or a multi-level approach (n=25) more than 5 years ago. A significant improvement of the neurological status could be seen even 5 years or more after surgery in both groups without differences. After one year no further improvement could be observed. In the single-level group a trend to a subsequent loss of lordotic correction could be seen. Anterior plates were only used in the multi-level group.

Conclusion: The anterior approach is an effective procedure to improve the symptoms of a CSM for many years. The risk of a multi-level pathology does not appear to exceed the risks of a single-level pathology concerning clinical long-term outcome after surgery. The clinical success is not hindered by a loss of correction in this specific setting.

Keywords: Degenerative disc disease; Spine; Surgery.