Comparison of outcomes following anterior versus posterior surgical approaches for cervical myelopathy: A retrospective analysis of 260 cases from a single institution

Aim: This study retrospectively evaluated clinical outcomes in patients diagnosed with cervical myelopathy who underwent surgical intervention using either anterior or posterior cervical spinal approaches.

Materials and Methods: Medical records and magnetic resonance imaging (MRI) datasets of patients treated between 2012 and 2025 were reviewed retrospectively. The two groups were compared based on age, sex, and preoperative and postoperative Modified Japanese Orthopaedic Association (mJOA) scores and Visual Analog Scale (VAS) scores. Age distribution between groups was assessed using the Student’s t-test. Pre- and postoperative mJOA scores were analyzed with both the Student’s t-test and paired sample t-test. Repeated measures analysis of variance (ANOVA) was applied to compare changes in preoperative and postoperative mJOA and VAS scores between the two surgical approach groups. 

Results: There was no statistically significant difference in preoperative mJOA scores between patients undergoing anterior and posterior approaches (P=0.120). Postoperative mJOA scores demonstrated a statistically significant improvement in both groups (P<0.001), with the posterior approach group achieving higher mean postoperative mJOA scores than the anterior group. Repeated measures ANOVA indicated that surgery had a positive effect on mJOA scores over time, particularly in patients treated with the posterior approach. The same analysis demonstrated a significant reduction in VAS scores postoperatively, suggesting a beneficial effect of both procedures on pain levels.

Conclusion: Both surgical approaches resulted in significant postoperative improvement in neurological function and pain severity among patients with cervical myelopathy. However, comparative analysis indicates that the posterior approach may provide superior functional outcomes based on postoperative mJOA scores.