Rationale for the Combined Front and Back Surgery in the Treatment of Cervical Spondylotic Myeloradiculopathy

We have retrospectively analyzed the clinical and radiological outcome in 22 cervical spondylotic myeloradiculopathy patients who underwent combined front anterior decompression and fusion) and back (open door laminoplasty) surgery between Mar. 1991 and Jan. 1995. Clinical symptoms were evaluated by Japanese Orthopaedic Association(JOA) score and the recovery rate. Plain radiogram and MIR were taken before and after surgery, and then the cervical curvature, change of body to canal ratio and the A-P compression ratio of the cord were measured and compared to the clinical symptoms. Results : The mean JOA score increased from 10.1±3.3 preoperatively to 14.7±1.4 at the final follow-up with a mean recovery rate of 64.4%. No patients deteriorated as a result of the combined procedure. Post-op. radiograms showed an increasement of body to ratios (average 0.69±0.09 pre-op. to 1.0±0.13 post-op.) and maintenance or recovery of cervical Lordosis. On MRI, the A-P compression ratios of the cord were increased with recovery of subarachnoid space after the operation in most cases (average 38.4±7.6 pre-op. to 55.7±7.2 post-op.). Conclusion : This combined procedure safely and effectively resulted in decompression of the spinal cord and good functional recovery in patients with 1) anterior and posterior pathology, 2) narrow spinal canal and large spondylotic bar or herniated disc encroaching the spinal canal more than 5mm, 3) narrow spinal canal and kyphotic deformity, 4) narrow spinal canal and segmental instability, 5) multisegmental cord compression and severe radiculopathy.