Table 4.

Common Anterior and Posterior Approaches.

Surgical Technique	Main Indications	Pros	Cons	Common Complications	Contraindications
Anterior cervical discectomy and fusion	Anterior pathology Kyphosis ≤2 levels	Less postoperative pain Lower infection rates Ability to decompress and correct cervical kyphosis Address patholgies causing radiculopathy	When 3 or more levels are involved, the complication rates with an anterior approach rise Bone graft complications Swallowing difficulty or hoarseness Difficulties treating posterior compressive pathologies	Nerve root injury (C5 nerve root palsy) Spinal cord injury Wound hematoma Hoarseness Dysphagia Esophageal perforation Carotid or vertebral artery injury Pseudarthrosis	Previous irradiation to anteior neck Shin on chest deformity Posterior pathology Aberrant vertebral artery Previous iatrogenic laryngeal nerve injury on contralateral side
Anterior corpectomy	Circumferential decompression of the ventral cervical spinal cord	More extensive decompression Fewer graft surfaces to fuse Provides source of autograft Can be combined with ACDF	Greater blood loss Increased operative time Higher incidence of complications	In addition to above Vertebral artery injury Durotomy CSF leak Adjacent segment degeneration	Severe osteoperosis Reconstruction >3 levels Aberrant vertebral artery Previous irradiation to anteior neck Previous iatrogenic laryngeal nerve injury on contralateral side Shin on chest deformity
Arthroplasty	1-2 level CSM	Preservation of segmental motion with maintenance of adequate stability	Significant degenerative changes at risk for further degenerative changes at the effected regions	New onset radiculopathy Subsidence Implant migration Ankylosed joint (formation of significant heterotopic bone around the implant)	Cervical kyphosis Cervical instability Cervical ankylosis Osteoporosis
Cervical laminectomy only	Posterior pathology Neutral to lordosis	Direct approach	Delayed postoperative kyphosis	C5 radiculopathy Durotomy CSF leak	Inability to tolerate prone position Active posterior infection Previous irradiation to posterior neck Shin on chest deformity Significant cervical kyphosis Significant instability
Cervical laminectomy and fusion	Posterior pathology Multilevel CSM	Multilevel stabilization More expansive decompression of posterior pathology while providing stabilization via instrumentation/fusion	Dependent on the ability of the cord to drift away from anterior lesions Complications related to misplaced screws	Nerve root injury (C5 palsy) Vertebral artery injury Wound infection CSF leak	Inability to tolerate prone position Active posterior infection Previous irradiation to posterior neck Significant cervical kyphosis
Cervical laminoplasty	“Tissue-sparing” alternative for spinal cord compression	Posterior elements preserved	Limited posterior decompression Late instability Inconsistent relief of neck pain	Delayed C5 nerve root injury Neck pain Reduced range of motion New-onset kyphosis	Inability to tolerate prone position Active posterior infection Previous irradiation to posterior neck Significant neck pain Significant kyphotic deformity Cervical spine instability
Combined ACDF and laminectomy and fusion	Significant focal kyphosis and posterior compressive pathology Multilevel decompression Instability	Increased stabilization Increased decompression	Technically more challenging Increased operative time Often require staging	Same as above posterior approaches	Inability to tolerate prone position Active posterior infection Previous irradiation to posterior neck

Abbreviations: ACDF, anterior cervical discectomy and fusion; CSF, cerebrospinal fluid; CSM, cervical spondylotic myelopathy.