Anterior cervical spinal surgery for multilevel cervical myelopathy

Background: In multilevel spinal cord compression caused by cervical spondylosis, surgeons face the choice of performing a posterior route as a laminectomy or laminoplasty, or an anterior route as multiple adjacent interbody decompressions or corpectomies. The anterior cervical operation is not considered by some clinicians because of concerns about complications and the complexity of multilevel anterior cervical surgery. Methods: In this retrospective study, 14 patients with multilevel cervical spondylosis who were operated on via an anterior route were enrolled to evaluate the complexity, safety, and clinical results. The collected parameters were operation time, blood loss, hospital days, and early and late complications for evaluating the operative complexity, radiographic follow-up for evaluating fusion, graft problems, implants problems, and the recovery rate using the Japanese Orthopaedic Association score (JOA score) for evaluating the operative results. Results: The mean operation time was 363.4 min, and blood loss was 431.4 ml. An early complication was noted in 1 patient with combined deep vein thrombosis and a pulmonary embolism. Late complications were screw breakage in 1 patient and screw loosening in 5 patients. The mean duration of follow-up was 21.9 months. The mean recovery rate of the JOA score was 38.8% postoperatively and 51.9% at the final follow-up. The fusion rate was 100% in this series. Conclusions: Anterior cervical decompression and fusion for multilevel stenosis requires a longer operation time than posterior procedures; however, the clinical results are satisfactory.