Comparison of Anterior Surgery Versus Posterior Surgery for the Treatment of Multilevel Cervical Spondylotic Myelopathy
Bibliographic record
Abstract
STUDY DESIGN: A meta-analysis. OBJECTIVE: To evaluate the impact of anterior versus posterior surgical approaches on outcomes in MCSM. BACKGROUND: Multilevel cervical spondylotic myelopathy (MCSM) is the most common cause of spinal cord dysfunction, and the clinical effectiveness of anterior versus posterior surgical approaches remains elusive. METHODS: A comprehensive search was conducted across electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, to evaluate the effects of anterior surgery versus posterior surgery on outcomes, such as Japanese Orthopedic Association (JOA) score, neck disability index (NDI) score, neck visual analog scale (VAS), blood loss, operation time, length of stay, cervical range of motion, cervical Cobb angle, and complications. The baseline characteristics of the included studies were assessed using the Newcastle-Ottawa Scale score to measure the risk of bias. RESULTS: In this meta-analysis, 14 retrospective and 6 prospective cohort studies, involving 2712 patients, were included. The analysis indicated no significant difference between the 2 groups in preoperative JOA score, postoperative JOA score, JOA recovery rate, postoperative neck VAS score, operation time, preoperative range of motion (ROM), or SF-36 score ( P =0.95, 0.15, 0.20, 0.31, 0.94, 0.33, and 0.43, respectively). However, the NDI score and blood loss were significantly lower in the anterior surgery group compared with the posterior surgery group ( P <0.04, P =0.0003). The anterior surgery group was also associated with shorter length of stay ( P <0.00001), while had higher rates of complications ( P =0.04). C2-7 Cobb angle and postoperative ROM were significantly lower in the anterior surgery group than those in the posterior surgery group ( P =0.0002 and 0.01, respectively). CONCLUSION: This meta-analysis found no clear advantage of 1 surgical approach over the other for MCSM in terms of neurological function recovery, as measured by JOA scores. The anterior approach was associated with improved NDI scores, lower blood loss, shorter length of stay, and better recovery of cervical lordosis, accompanied by limited postoperative mobility. Careful consideration should be given to potential complications, including dysphagia with the anterior surgery, axial pain, and C5 palsy with the posterior surgery.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.007 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".