gms | German Medical Science

Objective: Several decompressive techniques are used in the treatment of cervical spondylotic myelopathy; however, there is currently no evidence for the superiority of any one over another in terms of patient-rated outcomes. This comparative effectiveness study compared the outcomes of two types of decompression with fusion: anterior cervical discectomy (ACDF) and corpectomy (ACCF).

Method: The single center study was nested within the Eurospine Spine Tango data acquisition system. Inclusion criteria: consecutive patients between 2004–2011 presented with signs of myelopathy who underwent anterior cervical decompression with fusion due to degenerative stenosis for > 1 level. FU ≥12 mo. Before and 12 mo after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI; scored 0–10). At 12 mo FU, they also rated global treatment outcome (how much the operation had helped) and satisfaction with care on 5-point Likert scales.

Results: 100 ACDF and 65 ACCF patients met the inclusion criteria: age, gender, comorbidity and number of levels operated were not significantly different between the groups (p >0.05). Overall, baseline symptoms, function and quality of life tended to be worse in the ACDF group, significantly so for pain (p <0.05). Operation duration and blood loss were significantly lower in the ACDF group (p <0.05). Surgical complications were 10% in ACDF and 5% in ACCF (p=0.31). The 12-month questionnaire follow-up rate was 94%. All the patient-rated outcomes were slightly but not significantly better in ACDF than ACCF: respectively, 83.7% and 73.3% had a good global outcome (op helped/helped a lot) (p = 0.12)); 89.1% and 83.3% were satisfied/very satisfied with care (p = 0.30) and the reduction in the multidimensional COMI after 12 mo was 3.0 ± 2.7 and 2.1 ± 2.9 points (p = 0.07).

Conclusions: The worse baseline status of patients in the ACDF group may reflect the higher proportion of radicular symptoms (pain/neurologic deficits) compared with the ACCF group, for whom myelopathy (diffuse, neurological symptoms; less pain) is the predominant clinical picture. Similarly good patient-orientated outcomes after 1 year were shown for the two different surgical techniques; this precludes any conclusions regarding the superiority of one technique over the other, though it should be borne in mind that ACDF required a shorter surgery and was associated with less blood loss.