Single-stage surgical treatment of complex cervical spondylosis by combined anterior and posterior approach: an observational study

This study aimed to analyze the indications and outcomes of surgical treatment of complex cervical spondylotic myelopathy (CSM) by a single-stage combined anterior and posterior approach. Eighteen patients with CSM were operated between March 2007 and October 2012 by using the single-stage combined anterior and posterior approach to achieve decompression of the spinal cord. Patients' clinical and radiological data were analyzed to evaluate the clinical efficacy of the procedure. The mean operation time was 3.2 hours (range, 2.5-5 hours). Mean intraoperative blood loss was 650 mL (range, 480-1000 mL). Four cases had cerebrospinal fluid leakage during the surgery. Patients were followed-up for a mean duration of 38 months (range, 18 months to 7 years). The rates of neurological improvement and eligible rate of nerve function were 78.1% and 67.4%, respectively. Magnetic resonance imaging demonstrated repositioning of the dura mater posteriorly to its expected position and confirmed achievement of anterior and posterior decompression of the spinal cord. Computed tomography demonstrated a fully expanded spinal canal, and an average laminar opening angle of 45.2 degrees. Our results demonstrated that singlestage surgical treatment of CSM by a combined anterior and posterior approach successfully achieved complete spinal cord decompression and was associated with good mid-term clinical efficacy.