Abstract
Selecting the best surgical approach, either anterior or posterior, has been controversial in the management of degenerative cervical spine disorders. We usually selected anterior decompression and fusion if the neural compression was limited to one or two disc levels. Posterior decompression by laminoplasty was selected if the patients showed multiple compression at or more than three levels or significant compression by the yellow ligament. In this article, we reviewed our surgical series including cervical spondylosis (263 patients) and OPLL (91 patients) between 1996 and 2007. The purpose of this study is to discuss complications and problems in each approach, and to provide information for selecting the appropriate surgical approach in cervical spondylosis. A total of 227 patients were treated with anterior decompression and fusion, while 127 patients underwent bilateral open-door laminopalsty. The number of the patients showing postoperative upper limb symptoms was smaller in the anterior group than the posterior group (4 patients, 1.8% and 6 patients, 4.7%). The number of reoperations was larger in the anterior group than the posterior group (10 patients, 4.4% and 3 patients, 1.9%). The laminoplasty patients showed a significantly reduced range of neck motion by 11 degrees at follow-up. The literature review revealed several advantages and shortcomings in each approach that should be understood. Meticulous decompression procedures and fusion techniques will be needed for the anterior approach. Postoperative axial symptoms should be considered when the posterior approach is conducted. The appropriate surgical approach for each patient should be determined considering multiple factors such as the longitudinal extent of spinal cord compression, compression by the posterior elements such as the yellow ligament, the presence of kyphotic alignment and general condition.
