Surgical indication and challenges of anterior or posterior approach for cervical degenerative disease

Abstract

Over the years, there have been many discussions on the selection indication for surgical approaches to cervical spine diseases including OPLL, especially cervical spine degenerative diseases. The idea of approaching the lesion anteriorly with the main seat in the ventral side of the cervical spine is a perfect logical strategy and vice versa. However anterior intervertebral bony fusion is essential, except for some surgical techniques, after correct decompression of the spinal cord/nerve root from the ventral side. There is also the issue of adjacent intervertebral disorders after spinal fusion occurring, and it is more important to carefully observe long-term follow-up in Japan, where the frequency of developmental spinal canal stenosis is higher than overseas. As a surgical indication for the anterior or posterior approach of current textbook-like cervical spine degenerative disease: 1) anterior approach if the lesion is within 2 vertebrae, posterior approach if more. 2) In the past, those with kyphosis were contraindications for posterior decompression, but the posterior decompression effect of the spinal cord is expected if the cervical spine arrangement has a local kyphosis of 13 degrees or less is present. 3) For non-elderly patients with a background of developmental spinal canal stenosis, there is another strategy to choose the posterior approach first due to adjacent intervertebral disorders. 4) The OPLLs with a K-Line (+) is indicates a posterior approach, on the other hand, ones with a K-Line (−) indicate an anterior approach. Although each approach is a safe and established procedure, it is important to understand the type and frequency of complications and tips to prevent them. Regarding selecting the best surgical approach for cervical disorders, it is not a uniform one, but it must be generally selected considering age, general condition, and the social and family background of each patient all together. In addition, the use of artificial intervertebral discs will begin soon in Japan. It seems that improvements will also be made in anterior/posterior surgical selection for cervical degenerative disorders.