J Orthop Sci. 2025 Oct 15:S0949-2658(25)00280-5. doi: 10.1016/j.jos.2025.09.009. Online ahead of print.
ABSTRACT
STUDY DESIGN: A retrospective cohort study.
OBJECTIVES: While numerous studies have investigated surgical outcomes for cervical spondylosis, limited research has examined the impact of surgical techniques in patients with unilateral upper extremity proximal muscle weakness. This study compares clinical outcomes between anterior cervical decompression and fusion (ACDF) and posterior decompression (PD) with foraminotomy in patients with cervical spondylosis presenting with unilateral proximal muscle weakness.
METHODS: This study included 45 patients diagnosed with either cervical spondylotic amyotrophy (CSA) or cervical spondylotic radiculopathy (CSR) with unilateral proximal muscle weakness. Twenty CSA and five CSR patients underwent ACDF (anterior group), whereas 16 CSA and four CSR patients underwent PD with foraminotomy (posterior group). Muscle strength was assessed using the Manual Muscle Test (MMT) in the most improved muscle. Preoperative and postoperative MMT scores, Japanese Orthopaedic Association (JOA) scores, and imaging findings were analyzed.
RESULTS: The mean age at surgery was 63.2 years in the anterior group and 61.3 years in the posterior group (p = 0.31). No significant differences were observed in preoperative MMT (2.0 vs. 2.1, p = 0.75), JOA scores (13.9 vs. 13.5, p = 0.60), or C2-C7 angles (2.3° vs. -0.9°, p = 0.55). Postoperative JOA scores (15.6 vs. 15.1, p = 0.19) and C2-C7 angles (3.0° vs. 3.9°, p = 0.78) were comparable. Both groups showed significant improvement in MMT (p < 0.01); however, the difference in improvement between the ACDF and PD groups (2.5 vs. 1.9) did not reach statistical significance (p = 0.06).
CONCLUSIONS: Postoperative outcomes were similarly favorable for both ACDF and PD with foraminotomy, suggesting that each procedure represents an effective treatment option for cervical spondylotic disease presenting with unilateral proximal upper limb muscle weakness.
PMID:41102118 | DOI:10.1016/j.jos.2025.09.009