Outcome of Anterior Fusion Technique for Multilevel Cervical Spondylotic Myelopathy


  • Muhammad Hassan Raza Punjab Institute Of Neurosciences Lahore
  • Nabeel Chaudhary
  • Muhammad Akmal
  • Adeeb -UL-Hassan Punjab Institute of Neurosciences (PINS), Lahore General Hospital, Lahore
  • khalid Mahmood




Cervical Spondylotic Myelopathy, Neck Injury Scale, Cervical Movement range


Objective:   To asses’ surgical parameters, complications, clinical and radiological outcomes in the treatment of 2-, 3- and 4-levels Cervical Spondylotic Myelopathy .

Methods: A total of 90 patients with 2-, 3- or 4-level CSM who underwent anterior decompression and fusion procedures between January 2017 and October 2018 were divided into three different groups, the 2-level group (65 patients), the 3-level group (20 patients) and the 4-level group (5 patients). The clinical and Radiographic outcomes like Neck Disability Index (NDI) score, hospital stay, blood loss, operation time, fusion rate, cervical lordosis, cervical range of motion (ROM), and complications were compared between different procedures.

Results: At a minimum of 1-year follow-up, no statistical differences in NDI score, hospital stay, fusion rate and cervical lordosis were found among the 3 groups. However, the mean postoperative NDI score of the 4-level group was significantly higher than that in the other two groups , and in terms of postoperative total ROM, the 3- level group was superior to the 4-level group and inferior to 2-level group (P,0.05). The decrease rate of ROM in the 3-level group was significantly higher than that in the 2-level group, and lower than that in the 4-level group.

Conclusions: As the number of involved levels increased, surgical results become worse in terms of operative time, blood loss, NDI score, cervical ROM and complication rates postoperatively. An appropriate surgical procedure for multilevel CSM should be chosen according to comprehensive clinical evaluation before operation, thus reducing fusion and decompression levels if possible.


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