title: Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Wallace Clinical Trials Center, Yale University School of Medicine, Greenwich Hospital, Greenwich, CT 06830, USA. zoher.ghogawala@yale.edu
authors.forename: Zoher
authors.initials: Z
authors.lastname: Ghogawala
authors.forename: Brook
authors.initials: B
authors.lastname: Martin
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.forename: James
authors.initials: J
authors.lastname: Dziura
authors.forename: Subu N
authors.initials: SN
authors.lastname: Magge
authors.forename: Khalid M
authors.initials: KM
authors.lastname: Abbed
authors.forename: Erica F
authors.initials: EF
authors.lastname: Bisson
authors.forename: Javed
authors.initials: J
authors.lastname: Shahid
authors.forename: Jean-Valery C E
authors.initials: JV
authors.lastname: Coumans
authors.forename: Tanvir F
authors.initials: TF
authors.lastname: Choudhri
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
authors.forename: Ajit A
authors.initials: AA
authors.lastname: Krishnaney
authors.forename: Joseph T
authors.initials: JT
authors.lastname: King
authors.forename: William E
authors.initials: WE
authors.lastname: Butler
authors.forename: Fred G
authors.initials: FG
authors.lastname: Barker
authors.forename: Robert F
authors.initials: RF
authors.lastname: Heary
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D055009:Spondylosis / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States