• Neurosurgery · Mar 2011

    Multicenter Study Comparative Study Controlled Clinical Trial

    Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy.

    • Zoher Ghogawala, Brook Martin, Edward C Benzel, James Dziura, Subu N Magge, Khalid M Abbed, Erica F Bisson, Javed Shahid, Jean-Valery C E Coumans, Tanvir F Choudhri, Michael P Steinmetz, Ajit A Krishnaney, Joseph T King, William E Butler, Fred G Barker, and Robert F Heary.
    • Wallace Clinical Trials Center, Yale University School of Medicine, Greenwich Hospital, Greenwich, CT 06830, USA. zoher.ghogawala@yale.edu
    • Neurosurgery. 2011 Mar 1;68(3):622-30; discussion 630-1.

    BackgroundCervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction.ObjectiveTo 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.MethodsA 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.ResultsThe 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.ConclusionSurgery 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 (C) by the Congress of Neurological Surgeons

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