Comparison of different therapeutic approaches for multilevel cervical spondylotic myelopathy via imaging characteristics and clinical characteristics

Background To observe the effects of three surgical approaches including posterior cervical expansive open-door laminoplasty (EODL), posterior cervical decompression and fusion (PCDF), and anterior cervical discectomy with fusion (ACDF) on patients with multilevel cervical spondylotic myelopathy (MCSM). Methods 90 patients with MCSM from January 2023 to December 2024 were randomly divided into three groups, group ACDF, group EODL and group PCDF. The clinical efficacy, spinal function, cervical spine (CS) dysfunction index, sagittal parameters, pain severity and cervical spine X-ray films were compared among the three groups. The primary endpoint was the change in Japanese Orthopaedic Association (JOA) score from baseline to 90 days postoperatively. Secondary endpoints included Neck Disability Index (NDI), Visual Analogue Scale (VAS), and sagittal parameters. Results The cervical spine X-ray film results showed that, compared with before the surgery, the symptoms of the patients in the three treatment groups significantly improved 90 days after the surgery. Among them, the patients in the ACDF treatment group showed the most significant improvement. The clinical efficacy of group ACDF was better than that in other two groups ( P < 0.05). Postoperative 90 days, the JOA score of the three groups was increased, the JOA score in group ACDF > group PCDF > group EODL ( P < 0.05). Postoperative 90 days, the NDI of the three groups were decreased, with NDI in ACDF < PCDF < EODL. Postoperative 90 days, the C2-C7 lordosis in group ACDF > group EODL > group PCDF, the C2-C7 sagittal vertical axis in group ACDF < group EODL < group PCDF ( P < 0.05). At 90 days postoperatively, the VAS scores of the three groups decreased; the VAS score in ACDF < PCDF < EODL ( P < 0.05). Conclusion ACDF in treating MCSM is beneficial to improve the pain severity and therapeutic effect, better protect the physiological curvature of the cervical spine, avoid kyphosis, and ensure the sagittal balance of the cervical spine.