Comparison between anterior approaches and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy: A meta-analysis

• Anterior and posterior approaches for MCSM were meta-analyzed.
• Anterior approaches showed superiority in postoperative JOA and length of stay.
• Operation time of posterior approaches was shorter in OPLL patient.
• Neurological recovery rate of posterior approaches was higher in OPLL subgroup.
• The complication rate of posterior approaches was lower in spinal stenosis patients.

ObjectiveWe aimed to compare the clinical outcomes of anterior approaches (anterior cervical corpectomy with fusion, cervical discectomy with fusion) and posterior approaches (laminectomy, laminoplasty) in multilevel cervical spondylotic myelopathy (MCSM) patients using a systematic meta-analysis.MethodsPubMed, Embase, Scopus, and the Cochrane library were searched for literatures up to March 27, 2015 without language restriction. The reference lists of selected articles were also screened. Heterogeneity was identified using Q test and I2 statistic. A fixed effect model was used for homogeneous data and a random effects model for heterogeneous data. Weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Subgroup analysis was conducted according to the cause of MCSM.ResultsSeventeen articles were selected. Higher post-Japanese Orthopedic Association (JOA, P = 0.002) and shorter length of stay (P = 0.004) were found in anterior approaches group compared with posterior approaches. Moreover, operation time was shorter (P < 0.00001) and neurological recovery rate was higher (P = 0.005) in ossification of posterior longitudinal ligament patients underwent posterior approaches. Complication rate of posterior approaches was lower in spinal stenosis subgroup (P < 0.0001).ConclusionsMCSM patients performed anterior approaches showed superior post-JOA and shorten length of stay. However, the outcomes such as operation time and complication rate are associated with the cause of MCSM. Therefore, the favorable surgical strategy for MCSM still needs more studies.