This study examined the prognostic factors that affect the surgical outcome of anterior spinal fusion in patients with cervical compressive myelopathy (CCM).

A retrospective review of the result of surgical treatment in 49 cases of CCM using anterior spinal fusion surgical techniques. The study period was from June 1990 to June 2008, with a mean follow-up of 6.57 years. Seven patients died during the follow-up period because of other medical diseases. The Japanese Orthopaedic Association score for cervical myelopathy and recovery rate were used to assess the functional results of the remaining 42 cases.

A mean Japanese Orthopaedic Association score improvement from 10.21 to 14.23 points after the operation was observed. The overall recovery rate was 65.38%, with excellent or good results of 80%. After a year of follow-up, we did not find significant improvement or deterioration on the neurological status on further follow-up. Acute complications were not common. One patient underwent re-operation because of slipping of the graft during resuscitation after early post-operative acute myocardial infarction. This patient showed post-operative neurological deterioration. Two patients had subsidence of the graft, three had pseudo-arthrosis, and two had graft resorption. There were also three patients with degenerative changes of the adjacent vertebra. No re-operation was done for patients with these late complications in this review.

Anterior cervical decompression with bone fusion is a viable surgical option for patients with one level of anterior cervical cord compression, especially for patients with kyphosis or straight canal spine. For patients with two- to three-level involvement, anterior cervical decompression with bone fusion provides good functional result in proper selection of cases. We also identified some prognostic factors (male sex, symptoms less than 1 year, and age less than 70 years) in predicting a favourable outcome of anterior spinal fusion for CCM.