final follow-up, respectively. Both SL and L group appeared to be effective in reducing the axial pain. In the SL groups, JOACMEQ recovery rates were 16.5% in the cervical spine function, 18.9% in the upper extremity function, 19.8% in the lower extremity function, 1.2% in the bladder func- tion, and 10.6% in the QOL. The statistically significant improvements compared to preoperative scores were observed in the upper extremity function and the lower extremity function at the final follow-up. CONCLUSIONS: We have previously reported that the preservation of deep extensor muscles improves the postoperative axial pain, cervical spine function, and patients’ quality of life over two-year follow-up period. Further question is whether the traditional extensive laminoplasty with a wide range of decompression is necessary for the preservation of mid- term clinical results. The results demonstrated that the SL group showed the equivalent effectiveness to L group, and no neurologic deterioration in spinal cord function or re-operation was demonstrated during the aver- age 32-month follow-up periods. The super-selective laminoplasty using a deep extensor muscle-preserving approach was effective in improving the surgical outcomes of CSM and maintained the clinical effectiveness over two-year follow-up periods. However, further longer follow-up data should be analyzed in the future. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.146 111. Surgically Treated Cervical Myelopathy: A Functional Outcome Comparison Study between Multiple Level Anterior Cervical Decompression Fusion and Instrumentation and Posterior Laminoplasty Chusheng Seng, MD 1 , Benjamin Tow, MD 1 , Seang-Beng Tan, MD 2 , Wai-Mun Yue, MD, FRCS 1 ; 1 Singapore; 2 Singapore General Hospital, Singapore BACKGROUND CONTEXT: Multi- level cervical myelopathy can be treated with anterior cervical discetomy and fusion (ACDF) or anterior cer- vical corpectomy and fusion(ACCF) via the anterior approach and lamino- plasty for the posterior approach. Till date there is no proven superior approach. PURPOSE: To elucidate any potential advantage of one approach over the other with regards to clinical mid- term outcomes in this study. STUDY DESIGN/SETTING: A retrospective analysis of prospectively collected data in 116 patients with cervical myelopathy treated with mul- tiple- level anterior cervical decompression fusion and plating and poste- rior laminoplasty. PATIENT SAMPLE: 116 patients were studied. 64 patients underwent an- terior cervical discetomy and fusion(ACDF 2 levels and above) or anterior cervical corpectomy and fusion(ACCF one level and above). 52 patients un- derwent posterior cervical surgery(double trap door laminoplasty C3–C6 or C3–C7). OUTCOME MEASURES: We compare the Japan Orthopaedic Associa- tion Scores (JOA), Neck disability index scores(NDI), SF36 scores, Visual analogue score for neck pain(VASNP) and range of Motion(ROM) pre-op- eratively to 2 years. METHODS: Chi-square and 2-sided Student’s t-test were used to analyse the variables. RESULTS: Posterior surgery lasted 62 minutes in average shorter than an- terior surgery and showed better improvement in JOA scores at 6 months. Posterior group showed better preservation of neck range of motion though not statistically significant. No statistical difference in neck pain between the 2 groups. Complications were higher for anterior group: 2 post- oper- ative hematoma, 1 vocal cord paresis, 1 superficial wound infection versus 2 superficial wound infection in posterior group. No statistical difference between the 2 groups for JOA scores, SF36 scores, NDI, VAS neck pain and ROM through to 2 years. CONCLUSIONS: Our study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach in terms of shorter operating time, better improvement of JOA score at 6 months and a tendency towards lesser com- plications. No significant difference in neck pain between both groups. There is a need for a larger study that is prospectively randomized with long term follow up before we can confidently advocate one approach over the other in the management of cervical myelopathy. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.147 112. International Variations in the Clinical Presentation and Management of Cervical Spondylotic Myelopathy: One-Year Outcomes of the AOSpine Multicenter Prospective CSM-I Study Branko Kopjar, MD, PhD 1 , Michael Fehlings, MD, PhD, FRCSC 2 , Helton Luiz Defino, MD, PhD 3 , Giuseppe Barbagallo, MD 4 , R.H. Bartels, MD 5 , Paul Arnold, MD 6 , Mehmet Zileli, MD 7 , Yasutsugu Yukawa 8 , Osmar Moraes, MD 9 , Massimo Scerrati, MD, PhD 10 , Tomoaki Toyone, MD, PhD 11 , Masato Tanaka, MD 12 ; 1 University of Washington, Seattle, WA, USA; 2 Toronto Western Hospital, Toronto, ON, Canada; 3 Universidade De Sao Paulo Faculdade De Medicina De Ribeirao Preto, Ribeirao Preto, SP, Brazil; 4 A.O.V. Policlinico, Catania, Italy; 5 Radboud University Nijmegen Medical Center, Nijmegen, Netherlands; 6 Univeristy of Kansas Medical Center, Department of Neurosurgery, Kansas City, KS, USA; 7 EGE University Faculty of Medicine, Izmir, Turkey; 8 Nagoya University School of Medicine, Japan; 9 Sao Paulo, Brazil; 10 Ancona, Marche, Italy; 11 Teikyo University School of Medicine Chiba Medical Center, Chiba, Japan; 12 Okayama, Japan BACKGROUND CONTEXT: Recent studies conducted in North Amer- ica have demonstrated benefits of surgical treatment for symptomatic CSM. However, differences in pathology, comorbidities, treatment ap- proaches and cultural response to treatment may affect the generalizability of these findings at the global level. PURPOSE: To assess (i) the potential beneficial effects of surgery for CSM at a global level and (ii) whether the outcomes of surgical treatment for CSM vary according to region internationally. STUDY DESIGN/SETTING: Prospective, multi-center, cohort study in- volving sites in Europe, Asia, South America and North America. PATIENT SAMPLE: A total of 454 patients receiving surgery for clini- cally symptomatic CSM were enrolled in a prospective multicenter, cohort study which is continuing to accrue subjects at 16 sites in Europe, Asia, North and South America. OUTCOME MEASURES: Independent assessment of a series of generic and disease specific outcome measures including: modified Japanese Or- thopaedic Assessment scale (mJOA), Nurick Score, Neck Disability Index (NDI), SF36v2. METHODS: Changes in outcomes at 12 months were analyzed using us- ing multivariate techniques (SAS 9.2 PROC MIXED) adjusting for base- line differences in patient populations (age, gender, surgical approach, number of spinal levels and baseline outcome parameter value). RESULTS: There were 36% females ; average age was 56.1 years (SD 12.8). Patients underwent anterior (59%), posterior (39%) or circumferen- tial (2%) surgery. A total of 252 patients have completed the 12 month follow-up. At 12 months, all outcome variables improved significantly. The average improvements were as follows: mJOA 2.33 (SD 2.61, p !.01); NDI 10.3 (SD 21.4, p ! .01); Nurick 1.30 (SD 1.38, p ! .01); SF36v2 PCS 8.1 (SD 9.5, p ! .01); SF36v2 MCS 7.0 (SD 10.1, p !.01). In a multivariate adjusted model, the amount of improvement varied signif- icantly among the regions. Neurological outcomes (mJOA and Nurick) were better in North America and Asia Pacific compared to Latin America and Europe. SF36v2 PCS and MCS outcomes were better in Asia and Latin America than Europe. CONCLUSIONS: This large prospective global clinical study confirms the findings of a recent AOSpine North American study showing that 58S Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.