PMID- 36029264 OWN - NLM STAT- MEDLINE DCOM- 20230103 LR - 20230321 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 38 IP - 1 DP - 2023 Jan 1 TI - Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better? PG - 42-55 LID - 10.3171/2022.6.SPINE22110 [doi] AB - OBJECTIVE: The aim of this study was to determine whether multilevel anterior cervical discectomy and fusion (ACDF) or posterior cervical laminectomy and fusion (PCLF) is superior for patients with cervical spondylotic myelopathy (CSM) and high preoperative neck pain. METHODS: This was a retrospective study of prospectively collected data using the Quality Outcomes Database (QOD) CSM module. Patients who received a subaxial fusion of 3 or 4 segments and had a visual analog scale (VAS) neck pain score of 7 or greater at baseline were included. The 3-, 12-, and 24-month outcomes were compared for patients undergoing ACDF with those undergoing PCLF. RESULTS: Overall, 1141 patients with CSM were included in the database. Of these, 495 (43.4%) presented with severe neck pain (VAS score > 6). After applying inclusion and exclusion criteria, we compared 65 patients (54.6%) undergoing 3- and 4-level ACDF and 54 patients (45.4%) undergoing 3- and 4-level PCLF. Patients undergoing ACDF had worse Neck Disability Index scores at baseline (52.5 +/- 15.9 vs 45.9 +/- 16.8, p = 0.03) but similar neck pain (p > 0.05). Otherwise, the groups were well matched for the remaining baseline patient-reported outcomes. The rates of 24-month follow-up for ACDF and PCLF were similar (86.2% and 83.3%, respectively). At the 24-month follow-up, both groups demonstrated mean improvements in all outcomes, including neck pain (p < 0.05). In multivariable analyses, there was no significant difference in the degree of neck pain change, rate of neck pain improvement, rate of pain-free achievement, and rate of reaching minimal clinically important difference (MCID) in neck pain between the two groups (adjusted p > 0.05). However, ACDF was associated with a higher 24-month modified Japanese Orthopaedic Association scale (mJOA) score (beta = 1.5 [95% CI 0.5-2.6], adjusted p = 0.01), higher EQ-5D score (beta = 0.1 [95% CI 0.01-0.2], adjusted p = 0.04), and higher likelihood for return to baseline activities (OR 1.2 [95% CI 1.1-1.4], adjusted p = 0.002). CONCLUSIONS: Severe neck pain is prevalent among patients undergoing surgery for CSM, affecting more than 40% of patients. Both ACDF and PCLF achieved comparable postoperative neck pain improvement 3, 12, and 24 months following 3- or 4-segment surgery for patients with CSM and severe neck pain. However, multilevel ACDF was associated with superior functional status, quality of life, and return to baseline activities at 24 months in multivariable adjusted analyses. FAU - Chan, Andrew K AU - Chan AK AD - 1Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - 1Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Gottfried, Oren N AU - Gottfried ON AD - 1Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Park, Christine AU - Park C AD - 1Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Than, Khoi D AU - Than KD AD - 1Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Bisson, Erica F AU - Bisson EF AD - 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah. FAU - Bydon, Mohamad AU - Bydon M AD - 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Asher, Anthony L AU - Asher AL AD - 4Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina. FAU - Coric, Domagoj AU - Coric D AD - 4Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina. FAU - Potts, Eric A AU - Potts EA AD - 5Goodman Campbell Brain and Spine, Indianapolis, Indiana. FAU - Foley, Kevin T AU - Foley KT AD - 6Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee. FAU - Wang, Michael Y AU - Wang MY AD - 7Department of Neurological Surgery, University of Miami, Florida. FAU - Fu, Kai-Ming AU - Fu KM AD - 8Department of Neurosurgery, Weill Cornell Medical Center, New York, New York. FAU - Virk, Michael S AU - Virk MS AD - 8Department of Neurosurgery, Weill Cornell Medical Center, New York, New York. FAU - Knightly, John J AU - Knightly JJ AD - 9Atlantic Neurosurgical Specialists, Morristown, New Jersey. FAU - Meyer, Scott AU - Meyer S AD - 9Atlantic Neurosurgical Specialists, Morristown, New Jersey. FAU - Park, Paul AU - Park P AD - 10Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan. FAU - Upadhyaya, Cheerag AU - Upadhyaya C AD - 11Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri. FAU - Shaffrey, Mark E AU - Shaffrey ME AD - 12Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. FAU - Buchholz, Avery L AU - Buchholz AL AD - 12Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. FAU - Tumialan, Luis M AU - Tumialan LM AD - 13Barrow Neurological Institute, Phoenix, Arizona. FAU - Turner, Jay D AU - Turner JD AD - 13Barrow Neurological Institute, Phoenix, Arizona. FAU - Michalopoulos, Giorgos D AU - Michalopoulos GD AD - 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Sherrod, Brandon A AU - Sherrod BA AD - 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah. FAU - Agarwal, Nitin AU - Agarwal N AD - 14Department of Neurological Surgery, University of California, San Francisco, California; and. FAU - Chou, Dean AU - Chou D AD - 14Department of Neurological Surgery, University of California, San Francisco, California; and. FAU - Haid, Regis W AU - Haid RW AD - 15Atlanta Brain and Spine Care, Atlanta, Georgia. FAU - Mummaneni, Praveen V AU - Mummaneni PV AD - 14Department of Neurological Surgery, University of California, San Francisco, California; and. LA - eng PT - Journal Article DEP - 20220826 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Humans MH - Neck Pain/diagnosis/surgery MH - Treatment Outcome MH - Retrospective Studies MH - Quality of Life MH - *Spinal Fusion MH - *Spinal Cord Diseases/surgery MH - Diskectomy MH - Cervical Vertebrae/surgery MH - Pain, Postoperative/surgery MH - *Spinal Osteophytosis/surgery MH - *Spondylosis/complications/surgery OTO - NOTNLM OT - Quality Outcomes Database OT - anterior cervical discectomy and fusion OT - myelopathy OT - neck pain OT - patient-reported outcomes OT - posterior cervical laminectomy and fusion EDAT- 2022/08/28 06:00 MHDA- 2023/01/04 06:00 CRDT- 2022/08/27 09:22 PHST- 2022/01/24 00:00 [received] PHST- 2022/06/23 00:00 [accepted] PHST- 2022/08/28 06:00 [pubmed] PHST- 2023/01/04 06:00 [medline] PHST- 2022/08/27 09:22 [entrez] AID - 10.3171/2022.6.SPINE22110 [doi] PST - epublish SO - J Neurosurg Spine. 2022 Aug 26;38(1):42-55. doi: 10.3171/2022.6.SPINE22110. Print 2023 Jan 1.