You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Comparative Effectiveness of Ventral vs Dorsal Surgery for Cervical Spondylotic Myelopathy

Ghogawala, Zoher MD*†‡; Martin, Brook PhD, MPH∥; Benzel, Edward C MD¶; Dziura, James PhD§; Magge, Subu N MD#; Abbed, Khalid M MD†‡; Bisson, Erica F MD**; Shahid, Javed MD††; Coumans, Jean-Valery C E MD‡‡; Choudhri, Tanvir F MD§§; Steinmetz, Michael P MD¶; Krishnaney, Ajit A MD¶; King, Joseph T Jr MD, MSCE∥∥; Butler, William E MD‡‡; Barker, Fred G II MD‡‡; Heary, Robert F MD¶¶

doi: 10.1227/NEU.0b013e31820777cf
Research-Human-Clinical Studies: Editor's Choice

BACKGROUND: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction.

OBJECTIVE: To determine the feasibility of a randomized clinical trial comparing the clinical effectiveness and costs of ventral vs dorsal decompression with fusion surgery for treating CSM.

METHODS: A nonrandomized, prospective, clinical pilot trial was conducted. Patients ages 40 to 85 years with degenerative CSM were enrolled at 7 sites over 2 years (2007-2009). Outcome assessments were obtained preoperatively and at 3 months, 6 months, and 1 year postoperatively. A hospital-based economic analysis used costs derived from hospital charges and Medicare cost-to-charge ratios.

RESULTS: The pilot study enrolled 50 patients. Twenty-eight were treated with ventral fusion surgery and 22 with dorsal fusion surgery. The average age was 61.6 years. Baseline demographics and health-related quality of life (HR-QOL) scores were comparable between groups; however, dorsal surgery patients had significantly more severe myelopathy (P < .01). Comprehensive 1-year follow-up was obtained in 46 of 50 patients (92%). Greater HR-QOL improvement (Short-Form 36 Physical Component Summary) was observed after ventral surgery (P = .05). The complication rate (16.6% overall) was comparable between groups. Significant improvement in the modified Japanese Orthopedic Association scale score was observed in both groups (P < .01). Dorsal fusion surgery had significantly greater mean hospital costs ($29 465 vs $19 245; P < .01) and longer average length of hospital stay (4.0 vs 2.6 days; P < .01) compared with ventral fusion surgery.

CONCLUSION: Surgery for treating CSM was followed by significant improvement in disease-specific symptoms and in HR-QOL. Greater improvement in HR-QOL was observed after ventral surgery. Dorsal fusion surgery was associated with longer length of hospital stay and higher hospital costs. The pilot study demonstrated feasibility for a larger randomized clinical trial.

Author Information

*Wallace Clinical Trials Center, Greenwich, Connecticut; †Connecticut Spine Institute, Greenwich, Connecticut; ‡Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut; §Yale Center for Clinical Investigation, Yale University School of Medicine, New Haven, Connecticut; ∥Dartmouth College, Hanover, New Hampshire; ¶The Center for Spine Health and Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio; #Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts; **Department of Neurosurgery, University of Utah Health Sciences Center, Salt Lake City, Utah; ††Department of Neurosurgery, Danbury Hospital, Danbury, Connecticut; ‡‡Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts; §§Department of Neurosurgery, Mt. Sinai Hospital, New York, New York; ∥∥Section of Neurosurgery, VA Connecticut Healthcare System, West Haven, Connecticut; ¶¶Department of Neurosurgery, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey

Received, February 4, 2010.

Accepted, June 10, 2010.

Correspondence: Zoher Ghogawala, MD, Wallace Clinical Trials Center, Yale University School of Medicine, Greenwich Hospital, 5 Perryridge Road, Greenwich, CT 06830. E-mail

Copyright © by the Congress of Neurological Surgeons