Introduction: Cervical spondylotic myelopathy (CSM) represents a significant health challenge predominantly affecting older adults, often resulting in severe neurological impairment and disability. Despite the availability of numerous studies and surgical techniques, there is no clear consensus on the optimal surgical approach for managing multilevel CSM. Anterior cervical decompression and fusion (ACDF) and posterior laminoplasty are two widely employed surgical procedures. Both techniques have unique benefits and limitations, particularly concerning clinical outcomes, preservation of cervical function, and complication profiles. This study aimed to perform a systematic review and meta-analysis to compare the clinical and radiological outcomes of ACDF versus posterior laminoplasty .
Methods: A systematic search was conducted across major databases, including PubMed, Embase, and Scopus, using a combination of relevant MeSH terms such as "cervical," "spondylosis," "myelopathy," "laminoplasty," and "ACDF". The search concluded in April 2024. Abstracts and reference lists of identified articles were independently screened by two reviewers (LAW, FBN) with disagreements resolved by a third author (IKS). The review adhered to PRISMA guidelines and included studies that compared ACDF and laminoplasty in patients with multilevel cervical spondylotic myelopathy. Eligible studies reported outcomes including Japanese Orthopaedic Association (JOA) scores, intraoperative blood loss, range of motion (ROM), and complication rates. Data extraction and statistical analysis were conducted using Review Manager 5.3, applying random effects models based on heterogeneity levels.
Results: Out of 774 identified studies, 7 met the inclusion criteria, involving 288 patients treated with ACDF and 307 with laminoplasty. The meta-analysis found no significant difference in JOA score improvements between the groups (P = 0.62). ACDF was associated with lower intraoperative blood loss (P = 0.04) and better postoperative cervical lordosis (P<0.0001). Laminoplasty, however, preserved postoperative range of motion better (P<0.00001) and had a lower complication rate (12.95% vs. 25.9%, P = 0.0005). These findings suggest both procedures are effective, with each offering distinct advantages based on patient-specific priorities .
Conclusion: ACDF remains a viable surgical option for managing multilevel cervical spondylotic myelopathy, particularly for patients requiring reduced intraoperative blood loss and improved cervical alignment. However, laminoplasty offers advantages in preserving postoperative ROM and has a lower overall complication rate. The choice of surgical technique should be tailored to the individual patient based on clinical presentation, surgeon expertise, and patient-specific anatomical factors. Further research is recommended to validate these findings and explore long-term outcomes.