Treatment of Severe Cervical Spondylosis via Combined Anterior and Posterior (360 degree) Decompression and Fusion: Initial Results

John K. Ratliff, MD
Najeeb Thomas, MD
Rand Voorhies, MD (New Orleans, LA)

Surgical treatment of cervical spondylosis with associated myelopathy has been demonstrated to yield arrest of symptom progression and, in some cases, mild improvement of patient clinical status. However, major clinical improvements or reversal of myelopathic changes are less common, and concerns have been voiced in the literature as to the risk of late deterioration. Treatment of severe cervical spondylosis, with both anterior and posterior cord deformation/ compression, remains controversial. We believe that combined anterior and posterior decompressive surgery, with anterior and posterior fusion, provides a safe and clinically efficacious treatment for severe cervical spondylosis with associated myelopathy. Through chart review, we compiled pre–operative evaluations, operative records, and post– operative assessments of 1 3 patients treated with 360 degree cervical decompression and fusion over the last 4 years. Combined anterior and posterior cervical decompression and fusion is a safe and clinically efficacious alternative in the treatment of severe cervical myelopathy. Concerns over operative length, transfusion requirement, and peri– operative complications were not borne out in our patient cohort.

Combined anterior and posterior cervical decompression and fusion should be considered in the treatment of severe cervical myelopathy.