A Comparison between Anterior and Posterior Surgical Approaches in the Treatment of Cervical Spondylotic Myelopathy
Bibliographic record
Abstract
Introduction Cervical spondylotic myelopathy (CSM) is a common problem in our aging population. We aim to compare the efficacy and safety of anterior and posterior approaches in the surgical treatment of CSM using validated outcome measures in a prospective cohort study. Materials and Methods Patients with defined clinical features of CSM were recruited from three hospitals in Singapore between October 2009 and December 2010. A total of 17 participants were recruited, and baseline demographic variables and outcome measure scores were established. Namely, the modified Japanese Orthopaedic Association (mJOA) score, Nurick, Short Form-36 (SF-36) Health Survey Questionnaire score, and Neck Disability Index (NDI). Participants underwent decompressive surgery by anterior or posterior approach, with choice of technique left to surgeon preference. Scores were retaken at 6, 12, and 24 months after surgery for comparison against baseline, within and between groups through the follow-up period. Results Patients who underwent anterior approach surgery were younger, had fewer comorbidities, less extensive disease, better SF-36 physical functioning, and mJOA scores at baseline. Both groups had clinically significant improvement in scores based on validated minimum clinically important difference (MCID) values at the end of the 2-year follow-up period. Score improvement was more sustained in the anterior group, whereas in the posterior group improvement in scores was greatest at 6 months post-decompression, but declined thereafter (albeit to values still three times that at baseline). A patient who underwent posterior approach surgery developed anemia secondary to perioperative blood loss. There were no cases of implant-related complications or cases of revision surgery. Conclusion This study highlights the differences in patient and disease factors influencing choice of surgical approach and shows the safety and efficacy of CSM surgery regardless of approach.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".