Anterior Cervical Discectomy and Fusion Leads to Greater Functional and Physical Improvement Compared to Posterior Cervical Decompression and Fusion in Patients with Preoperative Myelomalacia

Authors

• Nicholas M. Wang, Thomas Jefferson UniversityFollow
• Yulia Lee, Rothman Orthopaedic Institute
• Mitchell Ng, Rothman Orthopaedic InstituteFollow
• Robert J. Oris, Rothman Orthopaedic Institute
• Chloe Herczeg, Rothman Orthopaedic Institute
• William A. Green, Rothman Orthopaedic InstituteFollow
• Joshua Mathew, Rothman Orthopaedic InstituteFollow
• Yasmine K. Eichbaum, Rothman Orthopaedic InstituteFollow
• Gregorio Baek, Rothman Orthopaedic Institute
• Morgan Hitchner, Rothman Orthopaedic InstituteFollow
• Jonathan Dalton, Rothman Orthopaedic Institute
• Alan S. Hilibrand, Rothman Orthopaedic InstituteFollow
• Christopher Kepler, Rothman Orthopaedic InstituteFollow
• Gregory D. Schroeder, Rothman Orthopaedic InstituteFollow
• Alex R. Vaccaro, Rothman Orthopaedic InstituteFollow

Document Type

Abstract

Publication Date

2-11-2026

Academic Year

2025-2026

Comments

Presented at the 2026 Scholarly Inquiry (SI) Research Project Symposium.

Abstract

Introduction/Purpose: Myelomalacia can signal advanced cervical myelopathy. Postoperative function and pain following surgery for cervical myelopathy may impact patient satisfaction. However, patient-reported outcome measures (PROMs) for patients with preoperative myelomalacia who undergo anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) has not been explored. This study compares PROMs between ACDF and PCDF for patients with preoperative myelomalacia.

Methods: A 2010 to 2023 single institution retrospective cohort study was conducted on adults with preoperative myelomalacia who underwent ACDF or PCDF not for tumor/trauma/infection. Demographics, preoperative diagnosis, surgical attributes, and manual motor testing was obtained. Strength of 3/5 or weaker was considered a motor deficit. PROMs (mJOA, SF-12 PCS/MCS, VAS Neck/Arm, NDI,) were obtained preoperatively and at 3/6/12 months postoperatively.

Results/Conclusions: From 146 patients, 90 underwent ACDF and 56 underwent PCDF. The PCDF cohort demonstrated higher rates of a new motor deficit (13.2% versus 0.00%, P=0.003) and overall motor deficit (18.2% versus 5.00%, P=0.026). The ACDF cohort demonstrated greater 1-year improvement across multiple PROMs (NDI, PCS, and VAS Neck/Arm) on bivariate analysis. Importantly, ACDF persisted as an independent predictor of greater 1-year improvement in mJOA (Estimate: 2.365, P=0.003) and PCS score (Estimate: 6.848, P=0.019) even when controlling for confounders.

ACDF is associated with a superior safety profile and better 1-year functional improvement compared to PCDF for patients with preoperative myelomalacia. While these results support ACDF as the preferred surgical approach, future studies using direct MRI measurements to assess myelomalacia instead of radiologist reports would enhance these results.

Recommended Citation

Wang, Nicholas M.; Lee, Yulia; Ng, Mitchell; Oris, Robert J.; Herczeg, Chloe; Green, William A.; Mathew, Joshua; Eichbaum, Yasmine K.; Baek, Gregorio; Hitchner, Morgan; Dalton, Jonathan; Hilibrand, Alan S.; Kepler, Christopher; Schroeder, Gregory D.; and Vaccaro, Alex R., "Anterior Cervical Discectomy and Fusion Leads to Greater Functional and Physical Improvement Compared to Posterior Cervical Decompression and Fusion in Patients with Preoperative Myelomalacia" (2026). Phase 1. Paper 28.
https://jdc.jefferson.edu/si_ctr_2028_phase1/28

Language

English