Skip Navigation LinksHome > March 2011 - Volume 68 - Issue 3 > Comparative Effectiveness of Ventral vs Dorsal Surgery for C...
Neurosurgery:
doi: 10.1227/NEU.0b013e31820777cf
Research-Human-Clinical Studies: Editor's Choice

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¶¶

Collapse Box

Abstract

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.

Copyright © by the Congress of Neurological Surgeons

Login

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.