We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Effect of Ventral vs Dorsal Spinal Surgery on Patient-Reported Physical Functioning in Patients With Cervical Spondylotic Myelopathy: A Randomized Clinical Trial.
- Authors
Ghogawala, Zoher; Terrin, Norma; Dunbar, Melissa R.; Breeze, Janis L.; Freund, Karen M.; Kanter, Adam S.; Mummaneni, Praveen V.; Bisson, Erica F.; Barker II, Fred G.; Schwartz, J. Sanford; Harrop, James S.; Magge, Subu N.; Heary, Robert F.; Fehlings, Michael G.; Albert, Todd J.; Arnold, Paul M.; Riew, K. Daniel; Steinmetz, Michael P.; Wang, Marjorie C.; Whitmore, Robert G.
- Abstract
<bold>Importance: </bold>Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction worldwide. It remains unknown whether a ventral or dorsal surgical approach provides the best results.<bold>Objective: </bold>To determine whether a ventral surgical approach compared with a dorsal surgical approach for treatment of cervical spondylotic myelopathy improves patient-reported physical functioning at 1 year.<bold>Design, Setting, and Participants: </bold>Randomized clinical trial of patients aged 45 to 80 years with multilevel cervical spondylotic myelopathy enrolled at 15 large North American hospitals from April 1, 2014, to March 30, 2018; final follow-up was April 15, 2020.<bold>Interventions: </bold>Patients were randomized to undergo ventral surgery (n = 63) or dorsal surgery (n = 100). Ventral surgery involved anterior cervical disk removal and instrumented fusion. Dorsal surgery involved laminectomy with instrumented fusion or open-door laminoplasty. Type of dorsal surgery (fusion or laminoplasty) was at surgeon's discretion.<bold>Main Outcomes and Measures: </bold>The primary outcome was 1-year change in the Short Form 36 physical component summary (SF-36 PCS) score (range, 0 [worst] to 100 [best]; minimum clinically important difference = 5). Secondary outcomes included 1-year change in modified Japanese Orthopaedic Association scale score, complications, work status, sagittal vertical axis, health resource utilization, and 1- and 2-year changes in the Neck Disability Index and the EuroQol 5 Dimensions score.<bold>Results: </bold>Among 163 patients who were randomized (mean age, 62 years; 80 [49%] women), 155 (95%) completed the trial at 1 year (80% at 2 years). All patients had surgery, but 5 patients did not receive their allocated surgery (ventral: n = 1; dorsal: n = 4). One-year SF-36 PCS mean improvement was not significantly different between ventral surgery (5.9 points) and dorsal surgery (6.2 points) (estimated mean difference, 0.3; 95% CI, -2.6 to 3.1; P = .86). Of 7 prespecified secondary outcomes, 6 showed no significant difference. Rates of complications in the ventral and dorsal surgery groups, respectively, were 48% vs 24% (difference, 24%; 95% CI, 8.7%-38.5%; P = .002) and included dysphagia (41% vs 0%), new neurological deficit (2% vs 9%), reoperations (6% vs 4%), and readmissions within 30 days (0% vs 7%).<bold>Conclusions and Relevance: </bold>Among patients with cervical spondylotic myelopathy undergoing cervical spinal surgery, a ventral surgical approach did not significantly improve patient-reported physical functioning at 1 year compared with outcomes after a dorsal surgical approach.<bold>Trial Registration: </bold>ClinicalTrials.gov Identifier: NCT02076113.
- Subjects
CERVICAL spondylotic myelopathy; SPINAL cord diseases; SPINAL surgery; CLINICAL trials; SURGERY; CERVICAL vertebrae; SPINAL cord; RESEARCH; SPINAL fusion; RESEARCH methodology; SPONDYLOSIS; RADIOGRAPHY; SURGICAL complications; MAGNETIC resonance imaging; MEDICAL cooperation; EVALUATION research; CONTINUING education units; TREATMENT effectiveness; COMPARATIVE studies; RANDOMIZED controlled trials; QUESTIONNAIRES; RESEARCH funding; STATISTICAL sampling; LAMINECTOMY; LONGITUDINAL method
- Publication
JAMA: Journal of the American Medical Association, 2021, Vol 325, Issue 10, p942
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2021.1233