The are many different types of surgery proposed for the treatment of CSM. The main distinction is whether the surgery is from the front (anterior) or back (posterior) of the neck. A recent large scale study has found that there is no overall difference in their efficacy. (1)(2) However some recent research may have re - opened the debate by suggesting some subtle differences...
At present CSM research is largely based on functional scores. There are various different types, but typically they are designed to given an overall impression of a patients function.
Hu Ren et al have been looking at specific components of function, e.g. just arm recovery.(3) In their small study of 124 patients undergoing treatment at more than one spinal level, although they again confirmed no overall difference between anterior and posterior surgery, they did find that arm recovery may be better if patients underwent anterior compared to posterior surgery.
This is a small study with limitations, and should not be taken at face value at this stage. However the results are interesting, as they re-affirm the need to individualise the type of treatment offered patients. At present surgical experience and the type of pathology are likely to be the main factors in determining the type of surgery offered. But perhaps the exact disability and types of symptoms may be pertinent. With ever advancing methods of assessing CSM, this is an important future research question.
1. Fehlings et al 2013. Anterior vs Posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North American CSM study in 278 patients Spine (Phil)
2. Luo et al. Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy. Eur Spine J.
3. Hu Ren et al 2016. Patterns of neurological recovery after anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of multilevel cervical spondylotic myelopathy Clin Spine Surg
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