Table 2: Major outcomes of the cervical surgical approaches from anterior to posterior to anterior-posterior.
| Authors | Study design | No. Patients | Procedures | Significant Outcomes | ||||||||
| Badhiwala, et al. [32] | Retrospective databasea | N = 1298 | 3-level ACDF, hybrid corpectomy, major complication compared to a 3-level ACDF, (aOR 2.82, p = 0.005) | -Among all 3 procedures, no difference in 30-day or mortality rate, reoperation, or readmission -Level ACCF was associated with a higher risk of discectomy -Multiple discectomies and hybrid procedures had comparable safety profiles -Multiple corpectomies associated with higher complications and longer hospital stay | ||||||||
| Lee CH, et al. [38] | Meta-analysis (7 studies) | N = 592 | Expansive | -No superiority over one approach laminoplasty, or laminectomy + on JOA grade and VAS score fusion. -Even loss of cervical lordosis in both groups | ||||||||
| Lau D, et al. [49] | Retrospective cohort | N = 145 | Laminoplasty, or LPSP | -Pain outcomes were similar between both groups in patients with similar post-op cervical lordosis and sagittal alignment -Better pain outcomes in laminoplasty pts. With greater cervical lordosis (> 20°) -LPSP associated with higher long-term complication rate, but better neurological outcomes compared to laminoplasty | ||||||||
| Retrospective | N = 72 | Single stage anterior- posterior- or posterior-anterior-posterior | Within 90 days following surgery: -30.6% major complications (eg, death, stroke) -80.6% minor complications (eg, PE, dysphagia) -13.9% reoperation rate | |||||||||
| Wewel JT, et al. [53] | ||||||||||||
| Veeravagu, et al. [51] | Retrospective | N = 35,962 | ACDF, posterior fusion, laminoplasty, anterior- posterior | Within 30 days after surgical discharge date -ACDF, posterior fusion, laminoplasty, and anterior- posterior had complication rates of 15.6%, 29.2%, 22.4%, 41.1%, respectively -Dysphagia rate of 4.1%, 1.6%, 0.35%, and 11.3% for ACDF, posterior fusion, laminoplasty, and anterior-posterior, respectively | ||||||||
| Fehlings MG, et al. [50] | Prospective multicenter | N = 302 | Anterior-only, posterior-only, or anterior-posterior | -Anterior-only, posterior-only, and 2-stage anterior-posterior had complication rates of 11%, 19%, and 37%, respectively -Dysphagia rate of 2.3%, 0.9%, and 21.1% for anterior-only, posterior-only, and combined approach, respectively | ||||||||
| Smith JS, et al. [52] | Prospective multicenter | N = 78 | Anterior-only, posterior-only, or anterior-posterior | -Anterior-only, posterior-only, and anterior-posterior had early complication rates of 27.3%, -Dysphagia rate of 8.1%, 2.6%, and 24.1% for anterior-only, posterior-only, and combined approach, respectively | ||||||||
a: Database was acquired from the national surgical quality improvement program (NSQIP) of the American college of surgeons (ACS); ACDF: Anterior cervical discectomy and fusion; ACCF: Anterior cervical corpectomy and fusion; aOR: Adjusted odds ratio; JOA: Japanese orthopaedic association; VAS: Visual analog scale; LPSP: Laminectomy with posterior spinal fusion; post-op: Post-operative; pts: Patients; PE: Pulmonary embolism.