A Comparison of the Anterior Approach and the Posterior Approach in Treating Multilevel Cervical Myelopathy: A Meta-Analysis

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Study Design:

A meta-analysis.


To compare the effectiveness and the safety of the anterior approach with those of the posterior approach for patients diagnosed with multilevel cervical myelopathy (MCM).

Summary of Background Data:

Although many studies had compared the outcomes of the anterior approach with that of the posterior approach for MCM in recent years, choosing a proper surgical approach is still a controversial issue .


We searched electronic databases for relevant studies that compared the anterior approach with the posterior approach for MCM. Then, data extraction and quality assessment were conducted. We used RevMan 5.3 for data analysis. A random effects model was used for heterogenous data, whereas a fixed-effects model was used for homogenous data.


A total of 25 nonrandomized controlled studies involving 1843 patients were included. No statistical difference was found with regard to the preoperative Japanese Orthopedic Association (JOA) score between the anterior group and the posterior group (P=0.08, 95% CI, −0.02 to 0.40). The postoperative JOA score and the recovery rate were higher in the anterior group as compared with the posterior group (P=0.02, 95% CI, 0.10–1.33; P=0.006, 95% CI, 2.33–13.90). In the subgroup analysis, better postoperative JOA scores and recovery rates were also obtained in the anterior group for cervical spondylotic myelopathy (P=0.0007, 95% CI, 0.29–1.09; P=0.01, 95% CI, 1.30–9.93). No significant differences were found in the complication rate, the revision rate, the operation time, and blood loss between the 2 groups (P=0.17, 95% CI, 0.89–1.95; P=0.21, 95% CI, 0.72–4.61; P=0.31, 95% CI, −20.20 to 63.30; P=0.88, 95% CI, −166.86 to 143.81).


The anterior approach is associated with a better postoperative neurological outcome compared with the posterior approach in cervical spondylotic myelopathy patients. Considering the complication rate, the revision rate, the operation time, and blood loss, the anterior approach appears to be as safe as the posterior approach. Further randomized controlled trials comparing the anterior approach and the posterior approach for MCM should be performed to make a more convincing conclusion.

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