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Comparative Effectiveness of Ventral vs Dorsal Surgery for Cervical Spondylotic Myelopathy
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Comparative Effectiveness of Ventral vs Dorsal Surgery for Cervical Spondylotic Myelopathy
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Journal Article
Comparative Effectiveness of Ventral vs Dorsal Surgery for Cervical Spondylotic Myelopathy
2011
Overview
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.
Publisher
Oxford University Press,Lippincott Williams & Wilkins,Wolters Kluwer Health, Inc
Subject
/ Aged
/ Aging
/ Biological and medical sciences
/ Cervical Vertebrae - surgery
/ Decompression, Surgical - methods
/ Female
/ Humans
/ Male
/ Neurosurgical Procedures - methods
/ Spinal Cord Compression - diagnosis
/ Spinal Cord Compression - etiology
/ Spinal Cord Compression - surgery
/ Spine
/ Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
