ACDF with the PCB cage-plate system versus laminoplasty for multilevel cervical spondylotic myelopathy.

STUDY

DESIGN

A nonrandomized controlled trial.

OBJECTIVE

To compare the clinical outcomes, radiographic changes, and complications of patients with multilevel cervical spondylotic myelopathy who underwent ACDF with the plate cage benezech (PCB) implant system and laminoplasty.

SUMMARY OF BACKGROUND DATA: Using anterior or posterior surgery for multilevel cervical spondylotic myelopathy continues to be the subject of considerable debate. Studies on the comparison of the 2 approaches are limited and few studies focus on anterior cervical discectomy and fusion (ACDF) versus laminoplasty.

METHODS

We evaluated 52 consecutive patients (25 patients for the ACDF group and 27 patients for the laminoplasty group) at our institution from 2002 to 2007. The clinical and radiographic backgrounds of both the groups were comparable. The mean independent follow-up duration was 25.4 months and 24.5 months, respectively (P>0.05). The clinical outcomes, radiographic changes, and complications were compared between the 2 groups.

RESULTS

As compared with the ACDF group, the laminoplasty group required a longer operative time (187.78 min vs. 115.92 min) and caused more operative blood loss (361.11 mL vs. 118.48 mL). Both the groups significantly improved the JOA score (P<0.001), and the recovery rate was similar (59.79% for the ACDF group vs. 59.54% for the laminoplasty group, P>0.05). The cervical ROM significantly decreased after surgery for both the groups (P<0.05), while the laminoplasty group had a lower decrease rate of ROM than the ACDF group (11.39% vs. 29.45%, P<0.05). The complications for the ACDF group were significantly more than the laminoplasty group (P<0.05).

CONCLUSIONS

Both ACDF with the PCB system and laminoplasty are effective therapies for multilevel cervical spondylotic myelopathy. As compared with laminoplasty, ACDF with the PCB system requires a shorter operative time and causes less operative blood loss, but has a higher decrease rate of the cervical ROM and more complications.