A Systematic Review on Neurological Outcomes for Cervical Degenerative Myelopathy After Anterior Decompression Surgery: Motion Preservation vs Fusion

Valérie N E Schuermans; Anouk Y J M Smeets; Lauren G C van de Kar; Sem M M Hermans; Inez Curfs; Toon F M Boselie; Henk van Santbrink

doi:10.14444/8320

A Systematic Review on Neurological Outcomes for Cervical Degenerative Myelopathy After Anterior Decompression Surgery: Motion Preservation vs Fusion

Valérie N E Schuermans^*, Anouk Y J M Smeets, Lauren G C van de Kar, Sem M M Hermans, Inez Curfs, Toon F M Boselie, Henk van Santbrink

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Although it is well established that surgically treated patients with cervical degenerative myelopathy (CDM) improve irrespective of the anterior decompression technique used, no consensus exists on what technique is superior in terms of neurological recovery. A general concern exists that anterior cervical discectomy with arthroplasty (ACDA) leads to less favorable outcomes in CDM due to microtrauma caused by preserved mobility. It is remarkable that current literature mainly uses pain scores to assess clinical outcomes after anterior decompression surgery, especially considering that pain may not be the most relevant outcome for CDM. This systematic review evaluated the literature concerning neurological outcomes in patients with CDM treated with anterior decompression surgery and assessed by validated myelopathy scores.

METHODS: Systematic searches were carried out in PubMed, EMBASE, Web of Science, CINAHL, and the Cochrane Library. Prospective studies were included when patients with isolated CDM were treated with anterior decompression surgery, and a validated myelopathy outcome score was used.

RESULTS: A total of 11 studies were included from the 16,032 identified studies. All studies used the modified Japanese Orthopedic Association (JOA) outcome score and showed improvement for all anterior techniques. The mean improvement in anterior cervical discectomy and fusion (ACDF) was 4.80 and 3.64 for the modified JOA and JOA outcome scores, respectively. The JOA for ACDA showed a mean improvement of 5.51. The overall quality of the included articles was low to moderate according to the Cochrane tool.

CONCLUSION: Neurological recovery of CDM is similar after all anterior decompression techniques, including ACDA when compared with ACDF.

CLINICAL RELEVANCE: The current literature gives no reason to dissuade the use of ACDA in cervical myelopathy.

LEVEL OF EVIDENCE: 3:

Original language	English
Pages (from-to)	969-976
Journal	International Journal of Spine Surgery
Volume	16
Issue number	6
Early online date	13 Jul 2022
DOIs	https://doi.org/10.14444/8320
Publication status	Published - Dec 2022

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10.14444/8320

Cite this

Schuermans, V. N. E., Smeets, A. Y. J. M., van de Kar, L. G. C., Hermans, S. M. M., Curfs, I., Boselie, T. F. M., & van Santbrink, H. (2022). A Systematic Review on Neurological Outcomes for Cervical Degenerative Myelopathy After Anterior Decompression Surgery: Motion Preservation vs Fusion. International Journal of Spine Surgery, 16(6), 969-976. https://doi.org/10.14444/8320

@article{db587ef338e1475db8552cd32069efcc,

title = "A Systematic Review on Neurological Outcomes for Cervical Degenerative Myelopathy After Anterior Decompression Surgery: Motion Preservation vs Fusion",

abstract = "BACKGROUND: Although it is well established that surgically treated patients with cervical degenerative myelopathy (CDM) improve irrespective of the anterior decompression technique used, no consensus exists on what technique is superior in terms of neurological recovery. A general concern exists that anterior cervical discectomy with arthroplasty (ACDA) leads to less favorable outcomes in CDM due to microtrauma caused by preserved mobility. It is remarkable that current literature mainly uses pain scores to assess clinical outcomes after anterior decompression surgery, especially considering that pain may not be the most relevant outcome for CDM. This systematic review evaluated the literature concerning neurological outcomes in patients with CDM treated with anterior decompression surgery and assessed by validated myelopathy scores.METHODS: Systematic searches were carried out in PubMed, EMBASE, Web of Science, CINAHL, and the Cochrane Library. Prospective studies were included when patients with isolated CDM were treated with anterior decompression surgery, and a validated myelopathy outcome score was used.RESULTS: A total of 11 studies were included from the 16,032 identified studies. All studies used the modified Japanese Orthopedic Association (JOA) outcome score and showed improvement for all anterior techniques. The mean improvement in anterior cervical discectomy and fusion (ACDF) was 4.80 and 3.64 for the modified JOA and JOA outcome scores, respectively. The JOA for ACDA showed a mean improvement of 5.51. The overall quality of the included articles was low to moderate according to the Cochrane tool.CONCLUSION: Neurological recovery of CDM is similar after all anterior decompression techniques, including ACDA when compared with ACDF.CLINICAL RELEVANCE: The current literature gives no reason to dissuade the use of ACDA in cervical myelopathy.LEVEL OF EVIDENCE: 3: ",

author = "Schuermans, {Val{\'e}rie N E} and Smeets, {Anouk Y J M} and {van de Kar}, {Lauren G C} and Hermans, {Sem M M} and Inez Curfs and Boselie, {Toon F M} and {van Santbrink}, Henk",

note = "This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright {\textcopyright} 2022 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.",

year = "2022",

month = dec,

doi = "10.14444/8320",

language = "English",

volume = "16",

pages = "969--976",

journal = "International Journal of Spine Surgery",

issn = "2211-4599",

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A Systematic Review on Neurological Outcomes for Cervical Degenerative Myelopathy After Anterior Decompression Surgery: Motion Preservation vs Fusion. / Schuermans, Valérie N E ; Smeets, Anouk Y J M; van de Kar, Lauren G C et al.
In: International Journal of Spine Surgery, Vol. 16, No. 6, 12.2022, p. 969-976.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - A Systematic Review on Neurological Outcomes for Cervical Degenerative Myelopathy After Anterior Decompression Surgery

T2 - Motion Preservation vs Fusion

AU - Schuermans, Valérie N E

AU - Smeets, Anouk Y J M

AU - van de Kar, Lauren G C

AU - Hermans, Sem M M

AU - Curfs, Inez

AU - Boselie, Toon F M

AU - van Santbrink, Henk

N1 - This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2022 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.

PY - 2022/12

Y1 - 2022/12

N2 - BACKGROUND: Although it is well established that surgically treated patients with cervical degenerative myelopathy (CDM) improve irrespective of the anterior decompression technique used, no consensus exists on what technique is superior in terms of neurological recovery. A general concern exists that anterior cervical discectomy with arthroplasty (ACDA) leads to less favorable outcomes in CDM due to microtrauma caused by preserved mobility. It is remarkable that current literature mainly uses pain scores to assess clinical outcomes after anterior decompression surgery, especially considering that pain may not be the most relevant outcome for CDM. This systematic review evaluated the literature concerning neurological outcomes in patients with CDM treated with anterior decompression surgery and assessed by validated myelopathy scores.METHODS: Systematic searches were carried out in PubMed, EMBASE, Web of Science, CINAHL, and the Cochrane Library. Prospective studies were included when patients with isolated CDM were treated with anterior decompression surgery, and a validated myelopathy outcome score was used.RESULTS: A total of 11 studies were included from the 16,032 identified studies. All studies used the modified Japanese Orthopedic Association (JOA) outcome score and showed improvement for all anterior techniques. The mean improvement in anterior cervical discectomy and fusion (ACDF) was 4.80 and 3.64 for the modified JOA and JOA outcome scores, respectively. The JOA for ACDA showed a mean improvement of 5.51. The overall quality of the included articles was low to moderate according to the Cochrane tool.CONCLUSION: Neurological recovery of CDM is similar after all anterior decompression techniques, including ACDA when compared with ACDF.CLINICAL RELEVANCE: The current literature gives no reason to dissuade the use of ACDA in cervical myelopathy.LEVEL OF EVIDENCE: 3:

AB - BACKGROUND: Although it is well established that surgically treated patients with cervical degenerative myelopathy (CDM) improve irrespective of the anterior decompression technique used, no consensus exists on what technique is superior in terms of neurological recovery. A general concern exists that anterior cervical discectomy with arthroplasty (ACDA) leads to less favorable outcomes in CDM due to microtrauma caused by preserved mobility. It is remarkable that current literature mainly uses pain scores to assess clinical outcomes after anterior decompression surgery, especially considering that pain may not be the most relevant outcome for CDM. This systematic review evaluated the literature concerning neurological outcomes in patients with CDM treated with anterior decompression surgery and assessed by validated myelopathy scores.METHODS: Systematic searches were carried out in PubMed, EMBASE, Web of Science, CINAHL, and the Cochrane Library. Prospective studies were included when patients with isolated CDM were treated with anterior decompression surgery, and a validated myelopathy outcome score was used.RESULTS: A total of 11 studies were included from the 16,032 identified studies. All studies used the modified Japanese Orthopedic Association (JOA) outcome score and showed improvement for all anterior techniques. The mean improvement in anterior cervical discectomy and fusion (ACDF) was 4.80 and 3.64 for the modified JOA and JOA outcome scores, respectively. The JOA for ACDA showed a mean improvement of 5.51. The overall quality of the included articles was low to moderate according to the Cochrane tool.CONCLUSION: Neurological recovery of CDM is similar after all anterior decompression techniques, including ACDA when compared with ACDF.CLINICAL RELEVANCE: The current literature gives no reason to dissuade the use of ACDA in cervical myelopathy.LEVEL OF EVIDENCE: 3:

U2 - 10.14444/8320

DO - 10.14444/8320

M3 - Article

C2 - 35831065

SN - 2211-4599

VL - 16

SP - 969

EP - 976

JO - International Journal of Spine Surgery

JF - International Journal of Spine Surgery

IS - 6

ER -