Anterior Cervical Discectomy and Fusion Achieves Outcomes Comparable to Laminoplasty in Patients With Spinal Cord-Canal Mismatch.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

To compare the clinical and radiographic outcomes of anterior cervical discectomy and fusion (ACDF) and laminoplasty in patients with cervical myelopathy complicated by spinal cord-canal mismatch (SCCM).

SUMMARY OF BACKGROUND DATA: SCCM, defined by a high spinal cord occupation ratio (SCOR), represents a congenital or developmental stenosis that may complicate surgical decision-making. Although laminoplasty provides indirect posterior decompression, ACDF offers direct ventral decompression and correction of local alignment. Comparative evidence in patients with SCCM-related myelopathy remains limited.

METHODS

A retrospective review was conducted of 323 patients who underwent ACDF and 244 who underwent laminoplasty between 2014 and 2020. Patients with SCOR ≥0.7 on magnetic resonance imaging and a minimum 2-year follow-up were included. Clinical outcomes included the Japanese Orthopaedic Association (JOA) score, recovery rate, and Visual Analog Scale (VAS) for neck and arm pain. Radiographic parameters (C2-C7 sagittal vertical axis, cervical lordosis) and incidence of adjacent segment degeneration (ASD) were analyzed.

RESULTS

Thirty-nine ACDF and 22 laminoplasty patients met the inclusion criteria. Baseline demographics were comparable, except for a higher prevalence of hypertension and more operated levels in the laminoplasty group. Both procedures significantly improved JOA scores with no difference in recovery rate (P=0.901). Neck and arm pain improved significantly after ACDF but not after laminoplasty, although between-group differences were not significant. Radiographic parameters were similar at follow-up. Symptomatic ASD occurred in 20.5% of patients with ACDF and in none after laminoplasty (P=0.079). Neither SCOR nor surgical approach independently predicted neurological recovery.

CONCLUSIONS

ACDF and laminoplasty achieved comparable neurological recovery in SCCM-related myelopathy. Laminoplasty may reduce ASD risk, whereas ACDF yields comparable outcomes when decompression is sufficient. SCCM alone should not contraindicate anterior surgery; approach selection should consider alignment, pathology, and symptoms.

LEVEL OF EVIDENCE: Level IV.