Comparison of Anterior and Posterior Approaches for Acute Traumatic Central Spinal Cord Syndrome with Multilevel Cervical Canal Stenosis without Cervical Fracture or Dislocation

Abstract

Introduction. This is a retrospective comparative study that aims to compare the benefits of different surgical approaches for patients with multilevel cervical canal stenosis (CCS) without cervical fracture or dislocation of acute traumatic central cord syndrome (ATCCS). Methods. From January 2015 to December 2018, 59 patients were included in the study. Among them, 35 patients (Group A) received anterior surgery and 24 patients (Group B) received posterior surgery. Primary outcome measures were American Spinal Cord Injury Association (Asia) grade, Japanese Orthopaedic Association (JOA) score, and recovery rate (RR). Secondary outcome measures included operation time, intraoperative blood loss, visual analogue scale (VAS) score, cervical sagittal parameters, and complications. Multivariate linear regression was used to analyze prognostic determinants. Results. Compared with Group B, Group A had longer operation time and more intraoperative blood loss ( $P<0.05$ ). However, the VAS score of Group B was higher than that of Group A at discharge ( $P<0.05$ ). There was no significant difference in cervical sagittal plane parameters between the two groups ( $P>0.05$ ). Postoperative complications were different in the two groups. During follow-up, the Asia grade, the JOA score, and RR of both groups improved ( $P<0.05$ ), but there were no significant differences between the two groups ( $P>0.05$ ). Younger age, earlier surgery, and better preoperative Asia grade were correlated with better prognosis. Conclusions. For patients with multilevel CCS without cervical fracture or dislocation of ATCCS, both surgical approaches had good outcomes. Although no significant differences were found in the primary outcome measures between the two groups, there were different recommendations for the secondary outcome measures. Younger age, earlier surgery, and better preoperative Asia grade were protective factors for better prognosis.