Spine - 2026-05-01 - Journal Article; Comparative Study; Multicenter Study
Prospective Comparison of Posterior Decompression and ACDF for 1- to 2-level Degenerative Cervical Myelopathy.
Yamamoto T, Nagoshi N, Yamane J, Okubo T, Kamata Y, Isogai N, Kono H, Fujiyoshi K, Kobayashi Y, Shibata R, Kitagawa T, Iga T, Takeda K, Suzuki S, Ozaki M, Matsumoto M, Nakamura M, Watanabe K
Topics
Key Takeaway
For 1- to 2-level DCM, ACDF produced significantly greater VAS neck pain improvement than posterior decompression (-22.6 vs. -6.1 mm, P=0.003), but both approaches yielded equivalent JOA neurological recovery at 2 years.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This prospective multicenter study from 10 Japanese institutions compared PD versus ACDF in 353 patients with 1- to 2-level DCM, adjusting for baseline differences using a general linear model. JOA scores, all five JOACMEQ domains, and most SF-36 domains were equivalent between groups. ACDF produced superior VAS neck pain (-22.6 vs. -6.1 mm), upper extremity pain/numbness (-32.7 vs. -18.3 mm), SF-36 bodily pain (22.8 vs. 10.1), and PCS (9.1 vs. 3.5) improvements, while PD yielded greater SF-36 social functioning gains (13.3 vs. 2.6).
Key Limitation
Non-randomized treatment allocation across institutions likely reflects surgeon and institutional preference bias, meaning the two groups may differ systematically in pathology severity, sagittal alignment, and compression morphology in ways not fully captured by the adjusted covariates.
Original Abstract
STUDY DESIGN
Prospective multicenter cohort study.
OBJECTIVE
To compare clinical outcomes between posterior decompression without fusion (PD) and anterior cervical discectomy and fusion (ACDF) in patients with 1- to 2-level degenerative cervical myelopathy (DCM).
SUMMARY OF BACKGROUND DATA
While numerous studies have assessed surgical strategies for multilevel DCM, limited evidence is available for cases involving only one or two levels.
METHODS
Among 1482 patients with degenerative cervical spine disorders from 10 Japanese institutions, 353 patients with 1- to 2-level DCM treated with either PD (n=233) or ACDF (n=120) and followed for 2 years were included. Clinical outcomes included the Japanese Orthopaedic Association (JOA) score, Visual Analog Scale (VAS), Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and Short Form-36 (SF-36). Group comparisons were adjusted for baseline characteristics and preoperative clinical outcomes using a general linear model.
RESULTS
Perioperative complication and reoperation rates did not significantly differ between groups. ACDF provided significantly greater improvements in VAS scores for neck pain (-22.6 vs . -6.1 mm, P =0.003), upper extremity pain/numbness (-32.7 vs . -18.3 mm, P =0.011), and SF-36 bodily pain (22.8 vs . 10.1, P =0.003) and physical component summary (PCS) scores (9.1 vs . 3.5, P =0.007) compared with the PD group. Conversely, PD yielded greater improvement in the SF-36 social functioning domain (13.3 vs . 2.6, P =0.011). No significant differences were observed in JOA scores, the five domains of JOACMEQ, or other SF-36 domains.
CONCLUSIONS
Both PD and ACDF provided comparable improvements in neurological function as measured by JOA and JOACMEQ scores, indicating similar efficacy in treating DCM. ACDF was more effective for alleviating neck and arm pain and enhancing physical health, while PD resulted in social functioning. Given similar complication rates, surgical strategy should be individualized based on each patient's clinical presentation.