Anterior Vs Posterior Procedures for Cervical Spondylotic Myelopathy: Prospective Randomized Clinical Trial (CSM)

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The University of Hong Kong (HKU)




Cervical Spondylotic Myelopathy


Procedure: ACDF
Procedure: Cervical laminoplasty

Study type


Funder types



A Vs P Decompression for CSM

Details and patient eligibility


There is no difference in surgical outcomes for patients suffering from cervical spondylotic myelopathy treated with anterior decompression and fusion or posterior cervical laminoplasty.

Full description

Cervical spondylotic myelopathy (CSM) is a syndrome consisting of symptoms and signs of cervical spinal cord compression caused by chronic degenerative changes of the cervical spine. CSM is the most serious and disabling condition of cervical spondylosis. Natural history studies showed that most of the CSM patients have a progressive deterioration course and no spontaneous regression occurs. It is suggested that the patients with moderate to severe CSM should be operated as early as possible before neurological deficits are too pronounced. Although there are many options available for the surgical treatment of cervical spondylotic myelopathy, the choice of surgical approach for CSM is still a controversial issue. Most of the surgeons select the surgical approach based on the number of levels involved and the alignment of the spine. Anterior procedure is generally recommended for patients with compression of less than 3 levels or in patients with kyphotic alignment, while posterior decompression is suggested for three or more levels of compression. Retrospective clinical study however has shown that both anterior and posterior surgeries could produce comparable results. There is no scientific data based on randomized, prospective clinical studies comparing the various surgical alternatives. The existing information does not clearly favor any one single approach or operative option. Since anterior and posterior surgeries carries different risks, it is important to identify the most appropriate surgical procedure that is supported by evidence rather than just by surgeons preference. The objective of this study is to compare the long-term clinical outcome of anterior approach versus posterior approach in the treatment of cervical myelopathy caused by degenerative disease of the cervical spine.


100 estimated patients




40 to 80 years old


No Healthy Volunteers

Inclusion criteria

  • Patients with transverse lesion type of cervical myelopathy caused by cervical spondylosis requiring surgery.
  • Involved levels limited to 1, 2 and 3 continuous levels

Exclusion criteria

  • Radiculomyelopathy
  • Cervical kyphosis
  • Cervical myelopathy caused by high energy trauma
  • Female > 70 years old or patients with severe osteoporosis
  • High anaesthetic risk
  • Cervical myelopathy other than transverse type
  • Cervical myelopathy caused by ossification of posterior longitudinal ligament or inter-vertebral disc herniation.

Trial design

100 participants in 4 patient groups

Cervical spondylotic myelopathy treated with anterior cervical decompression and fusion
Procedure: ACDF
CSM - Cervical laminoplasty
Cervical spondylotic myelopathy treated with cervical laminoplasty
Procedure: Cervical laminoplasty

Trial contacts and locations



Central trial contact

Wai Yuen Cheung, MBBS, FRCS

Data sourced from

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