Cervical Spondylotic Myelopathy Clinical Trial
Official title:
A Comparison of Anterior and Posterior Procedures for the Surgical Management of Cervical Spondylotic Myelopathy: Prospective Randomized Clinical Trial
There is no difference in surgical outcomes for patients suffering from cervical spondylotic myelopathy treated with anterior decompression and fusion or posterior cervical laminoplasty.
Cervical spondylotic myelopathy (CSM) is a syndrome consisting of symptoms and signs of
cervical spinal cord compression caused by chronic degenerative changes of the cervical
spine. CSM is the most serious and disabling condition of cervical spondylosis. Natural
history studies showed that most of the CSM patients have a progressive deterioration course
and no spontaneous regression occurs. It is suggested that the patients with moderate to
severe CSM should be operated as early as possible before neurological deficits are too
pronounced.
Although there are many options available for the surgical treatment of cervical spondylotic
myelopathy, the choice of surgical approach for CSM is still a controversial issue. Most of
the surgeons select the surgical approach based on the number of levels involved and the
alignment of the spine. Anterior procedure is generally recommended for patients with
compression of less than 3 levels or in patients with kyphotic alignment, while posterior
decompression is suggested for three or more levels of compression. Retrospective clinical
study however has shown that both anterior and posterior surgeries could produce comparable
results. There is no scientific data based on randomized, prospective clinical studies
comparing the various surgical alternatives. The existing information does not clearly favor
any one single approach or operative option. Since anterior and posterior surgeries carries
different risks, it is important to identify the most appropriate surgical procedure that is
supported by evidence rather than just by surgeons preference.
The objective of this study is to compare the long-term clinical outcome of anterior
approach versus posterior approach in the treatment of cervical myelopathy caused by
degenerative disease of the cervical spine.
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Observational Model: Cohort, Time Perspective: Prospective
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