{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T04:28:38Z","timestamp":1793766518119,"version":"4.6.1"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2017,6,21]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Surgeons often choose between 2 different approaches (anterior and posterior) for surgical treatment of degenerative cervical myelopathy on the basis of imaging features of spinal cord compression, the number of levels affected, and the spinal alignment. However, there is a lack of consensus on which approach is preferable. The objective of the present study was to use magnetic resonance imaging (MRI)-based propensity-score-matched analysis to compare postoperative outcomes between the anterior and posterior surgical approaches for degenerative cervical myelopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 757 patients were enrolled in 2 prospective multicenter AOSpine studies, which involved 26 international sites. Preoperative MRIs were reviewed to characterize the causes of the cord compression, including single-level disc disease, multilevel disc disease, ossification of the posterior longitudinal ligament, enlargement of the ligamentum flavum, vertebral subluxation\/spondylolisthesis, congenital fusion, number of compressed levels, or kyphosis. The propensity to choose anterior decompression was calculated using demographic data, preoperative MRI findings, and the modified Japanese Orthopaedic Association (mJOA) scores in a logistic regression model. We then performed 1-to-1 matching of patients who had received anterior decompression with those who had the same propensity score but had received posterior decompression to compare 2-year postoperative outcomes and 30-day perioperative complication rates between the 2 groups after adjustment for background characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 435 cases were included in the propensity score calculation, and 1-to-1 matching resulted in 80 pairs of anterior and posterior surgical cases; 99% of these matched patients had multilevel compression. The anterior and posterior groups did not differ significantly in terms of the postoperative mJOA score (15.1 versus 15.3, p = 0.53), Neck Disability Index (20.5 versus 24.1, p = 0.44), or Short Form-36 (SF-36) Physical Component Summary (PCS) score (41.9 versus 40.9, p = 0.30). The overall rates of perioperative complications were similar between the 2 groups (16% versus 11%, p = 0.48); however, dysphagia\/dysphonia was reported only in the anterior group whereas surgical site infection and C5 radiculopathy were reported only in the posterior group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Anterior and posterior decompression for degenerative cervical myelopathy resulted in similar postoperative outcomes and rates of complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.16.00882","type":"journal-article","created":{"date-parts":[[2017,6,21]],"date-time":"2017-06-21T07:08:49Z","timestamp":1498028929000},"page":"1013-1021","source":"Crossref","is-referenced-by-count":88,"title":["Comparison of Anterior and Posterior Surgery for Degenerative Cervical Myelopathy"],"prefix":"10.2106","volume":"99","author":[{"given":"So","family":"Kato","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aria","family":"Nouri","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongjin","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Nori","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Tetreault","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"18","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.2106\/JBJS.L.00589","article-title":"Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study","volume":"95","author":"Fehlings","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"E675","DOI":"10.1097\/BRS.0000000000000913","article-title":"Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis","volume":"40","author":"Nouri","year":"2015","journal-title":"Spine (Phila Pa 1976)."},{"issue":"22","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1097\/BRS.0b013e3182a7f4de","article-title":"Symptomatic progression of cervical myelopathy and the role of nonsurgical management: a consensus statement","volume":"38","author":"Fehlings","year":"2013","journal-title":"Spine (Phila Pa 1976)."},{"issue":"Suppl 1","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1227\/NEU.0000000000000781","article-title":"Surgery vs conservative care for cervical spondylotic myelopathy: surgery is appropriate for progressive myelopathy","volume":"62","author":"Ghogawala","year":"2015","journal-title":"Neurosurgery."},{"issue":"17","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1097\/BRS.0000000000000988","article-title":"A global perspective on the outcomes of surgical decompression in patients with cervical spondylotic myelopathy: results from the prospective multicenter AOSpine International study on 479 patients","volume":"40","author":"Fehlings","year":"2015","journal-title":"Spine (Phila Pa 1976)."},{"issue":"7","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"420","DOI":"10.5435\/JAAOS-22-07-420","article-title":"Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine","volume":"22","author":"An","year":"2014","journal-title":"J Am Acad Orthop Surg."},{"key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.wneu.2015.09.044","article-title":"The association of cervical spine alignment with neurologic recovery in a prospective cohort of patients with surgical myelopathy: analysis of a series of 124 cases","volume":"86","author":"Shamji","year":"2016","journal-title":"World Neurosurg."},{"issue":"1","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/biomet\/70.1.41","article-title":"The central role of the propensity score in observational studies for causal 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A comparative study of results in multisegmental cervical spondylotic myelopathy","volume":"17","author":"Yonenobu","year":"1992","journal-title":"Spine (Phila Pa 1976)."},{"issue":"13","key":"bib18-20230810","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1097\/00007632-200107010-00011","article-title":"Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years","volume":"26","author":"Wada","year":"2001","journal-title":"Spine (Phila Pa 1976)."},{"issue":"23","key":"bib19-20230810","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1097\/BRS.0b013e3181feeeb2","article-title":"Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy","volume":"36","author":"Hirai","year":"2011","journal-title":"Spine (Phila Pa 1976)."},{"issue":"4","key":"bib20-20230810","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/BSD.0b013e3181e9f294","article-title":"ACDF with the PCB cage-plate system versus laminoplasty for multilevel cervical spondylotic myelopathy","volume":"24","author":"Liu","year":"2011","journal-title":"J Spinal Disord Tech."},{"issue":"3","key":"bib21-20230810","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1227\/NEU.0b013e31820777cf","article-title":"Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy","volume":"68","author":"Ghogawala","year":"2011","journal-title":"Neurosurgery."},{"issue":"26","key":"bib22-20230810","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1097\/BRS.0000000000000047","article-title":"Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 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Studies"],"short-title":[],"issued":{"date-parts":[[2017,6,21]]},"references-count":39,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.16.00882","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6,21]]}}}