A comparative study of surgical approaches for cervical compressive myelopathy

Since 1986, the authors have used anterior decompression and fusion to trea t patients with one- or two-level lesions without spinal canal stenosis (Gr oup A) and laminoplasty for patients with more than three-level lesions or spinal canal stenosis (Group P), The aim of this study was to compare surgi cal outcomes of anterior and posterior approaches for patients with cervica l myelopathy because of spondylosis and disc herniation and to determine th e cause of poor neurologic recovery after surgery. One hundred thirty-six p atients were followed up for an average of 5.6 years. There were no signifi cant differences in gender, preoperative neurologic deficits, axial symptom s, or duration of symptoms before surgery between the two groups, Mean reco very rates for disc herniations were 71.1% and 71.9% in Groups A and P, res pectively. For spondylosis, mean recovery rates were 49.0% and 58.6% in Gro ups A and P, respectively. There were no differences in recovery rate for p atients with either spinal disorder between Groups A and P, The neurologic recovery of patients with kyphotic spinal cord was inferior to that of pati ents with lordotic or straight spinal cord. It is possible that acquisition and maintenance of lordosis result in improvement of clinical outcomes aft er surgery for patients with myelopathy.