Prospective Comparison of Posterior Decompression and ACDF for 1- to 2-level Degenerative Cervical Myelopathy

Prospective multicenter cohort study. To compare clinical outcomes between posterior decompression without fusion (PD) and anterior cervical discectomy and fusion (ACDF) in patients with 1- to 2-level degenerative cervical myelopathy (DCM). While numerous studies have assessed surgical strategies for multilevel DCM, limited evidence is available for cases involving only one or two levels. Among 1482 patients with degenerative cervical spine disorders from 10 Japanese institutions, 353 patients with 1- to 2-level DCM treated with either PD (n=233) or ACDF (n=120) and followed for 2 years were included. Clinical outcomes included the Japanese Orthopaedic Association (JOA) score, Visual Analog Scale (VAS), Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and Short Form-36 (SF-36). Group comparisons were adjusted for baseline characteristics and preoperative clinical outcomes using a general linear model. Perioperative complication and reoperation rates did not significantly differ between groups. ACDF provided significantly greater improvements in VAS scores for neck pain (-22.6 vs . -6.1 mm, P =0.003), upper extremity pain/numbness (-32.7 vs . -18.3 mm, P =0.011), and SF-36 bodily pain (22.8 vs . 10.1, P =0.003) and physical component summary (PCS) scores (9.1 vs . 3.5, P =0.007) compared with the PD group. Conversely, PD yielded greater improvement in the SF-36 social functioning domain (13.3 vs . 2.6, P =0.011). No significant differences were observed in JOA scores, the five domains of JOACMEQ, or other SF-36 domains. Both PD and ACDF provided comparable improvements in neurological function as measured by JOA and JOACMEQ scores, indicating similar efficacy in treating DCM. ACDF was more effective for alleviating neck and arm pain and enhancing physical health, while PD resulted in social functioning. Given similar complication rates, surgical strategy should be individualized based on each patient's clinical presentation.