Comparison of the Outcomes of Anterior versus Posterior Approaches in Multilevel Cervical Prolapsed Intervertebral Discs




Multilevel prolapsed intervertebral discs, cervical laminoplasty, anterior cervical discectomy and fusion, posterior cervical decompression


Objective:  To compare outcomes of the anterior versus posterior approach in multilevel cervical prolapsed intervertebral discs.

Materials and Methods:  This is a prospective study conducted on 40 patients, 20 in each group in the Department of Neurosurgery of a tertiary care hospital. Group A patients were operated on by the anterior cervical approach and Group B was operated by the posterior cervical approach. Postoperatively all the patients were followed to assess the outcome, neurological deficit.

Results:  Mean age in Group A was 38 years while in Group B, it was 53 years. Group A had 65% male and 35% female patients while Group B had 60% male and 40% female patients. In Group A, 9 (45%) patients had radiculopathy while 11 (55%) patients had myelopathy, while in Group B 7 (35%) developed radiculopathy, and 13 (65%) patients developed myelopathy. We assessed the patients postoperatively and found that in Group A, 18 (90%) patients were improved and 2 (10%) patients had clinically shown worse outcomes. While in Group B, 15 (75%) patients had improvement, and 5 (25%) patients had worse outcomes.

Conclusion:  The anterior approach had a short hospital stay and early recovery which makes it a more commonly used procedure by surgeons as compared to the posterior approach the outcome results of our study also showed that the anterior approach was good and had better functional outcomes than the posterior approach, but the difference was not significant statistically.


Sharrak S, Al Khalili Y. Cervical Disc Herniation. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

Rhee JM, Yoon T, Riew KD. Cervical radiculopathy. J Am Acad Orthop Surg. 2007 Aug;15(8):486-94. doi: 10.5435/00124635-200708000-00005. PMID: 17664368.

Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011 Oct;7(3):265-72. doi: 10.1007/s11420-011-9218-z. Epub 2011 Sep 9. PMID: 23024624; PMCID: PMC3192889.

Donnally III CJ, Hanna A, Odom CK. Cervical Myelopathy. [Updated 2022 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

Iyer S, Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med. 2016 Sep;9(3):272-80. doi: 10.1007/s12178-016-9349-4. PMID: 27250042; PMCID: PMC4958381.

Lawrence BD, Jacobs WB, Norvell DC, Hermsmeyer JT, Chapman JR, Brodke DS. Anterior versus posterior approach for treatment of cervical spondylotic myelopathy: a systematic review. Spine. 2013;38(22S):S173-S82.

Mohandas A, Summa C, Worthington WB, Lerner J, Foley KT, Bohinski RJ, et al. Best practices for outpatient anterior cervical surgery: results from a delphi panel. Spine. 2017;42(11):E648-E59.

Zhang H-X, Shao Y-D, Chen Y, Hou Y, Cheng L, Si M, et al. A prospective, randomized, controlled multicentre study comparing cervical disc replacement with anterior cervical decompression and fusion. International orthopaedics. 2014;38(12):2533-41

Joo PY, Jayaram RH, McLaughlin WM, Ameri B, Kammien AJ, Arnold PM, Grauer JN. Four-level anterior versus posterior cervical fusions: Perioperative outcomes and five-year reoperation rates: Outcomes after four-level anterior versus posterior cervical procedures. N Am Spine Soc J. 2022 Mar 24;10:100115. doi: 10.1016/j.xnsj.2022.100115. PMID: 35392022; PMCID: PMC8980614.

Lawrence, Brandon D. MD*; Jacobs, W. Bradley MD†; Norvell, Daniel C. PhD‡; Hermsmeyer, Jeffrey T. BS‡; Chapman, Jens R. MD§; Brodke, Darrel S. MD*. Anterior Versus Posterior Approach for Treatment of Cervical Spondylotic Myelopathy: A Systematic Review. Spine: October 15, 2013 - Volume 38 - Issue 22S - p S173-S182 doi: 10.1097/BRS.0b013e3182a7eaaf

Yang J-S, Chu L, Chen L, Chen F, Ke Z-Y, Deng Z-L. Anterior or posterior approach of full-endoscopic cervical discectomy for cervical intervertebral disc herniation? A comparative cohort study. Spine. 2014;39(21):1743-50.

Audat ZA, Fawareh MD, Radydeh AM, Obeidat MM, Odat MA, Bashaireh KM, Barbarawi MM, Nusairat MT, Ibraheem AB, Audat MZ. Anterior versus posterior approach to treat cervical spondylotic myelopathy, clinical and radiological results with long period of follow-up. SAGE Open Med. 2018 Apr 10;6:2050312118766199. doi: 10.1177/2050312118766199. PMID: 29662675; PMCID: PMC5898653.

Abou-zeid, Ahmed & Hamada, Salah. (2015). Anterior Versus Posterior Approach for Multilevel Cervical Spondylotic Myelopathy. Egyptian Spine Journal. 13. 3-11. 10.21608/esj.2015.3946.

Fehlings MG, Barry S, Kopjar B, et al. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine (Phila Pa 1976) 2013; 38(26): 2247–2252






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