Comparison of the safety and efficacy of anterior 'skip' corpectomy versus posterior decompression in the treatment of cervical spondylotic myelopathy.

BACKGROUND: The aim of this study was to compare the therapeutic effects of anterior 'skip' corpectomy with posterior decompression for treating four-level cervical spondylotic myelopathy. METHODS: Operation time and blood loss during the operation for the anterior and posterior approach groups were recorded. Patients were examined with cervical lateral radiography before and after the operation to measure Cobb's angle and postoperatively to monitor bony fusion. Surgery-, instrumentation-, and graft-related complications were assessed and recorded. RESULTS: The surgical aspects of both anterior 'skip' corpectomy and posterior decompression went smoothly, with mean durations of 2.5 and 2.1 h, respectively, and mean blood loss volumes of 250 and 380 mL, respectively. In the anterior approach group, the complications included axial pain in five cases and transient hoarseness in two. Radiography revealed titanium mesh subsidence in two cases and plate or screw dislodgement in one case. In the posterior approach group, C5 nerve root palsy was present in 2 patients, axial pain in 15, and cerebrospinal fluid leakage in 3. The mean Japanese Orthopaedic Association scores showed that the recovery rate was significantly higher in the anterior approach group than in the posterior approach group (p < 0.05). CONCLUSIONS: 'Skip' corpectomy has comparable safety and better efficacy than posterior decompression in the treatment of four-level cervical spondylotic myelopathy.