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; Robert F. Heary

doi:10.1227/NEU.0b013e31820777cf

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, Robert F. Heary

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107 Scopus citations

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.

Original language	English
Pages (from-to)	622-630
Number of pages	9
Journal	Neurosurgery
Volume	68
Issue number	3
DOIs	https://doi.org/10.1227/NEU.0b013e31820777cf
State	Published - Mar 2011

Keywords

Cervical spondylotic myelopathy
Clinical trial
Cost-effectiveness analysis
Outcomes

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10.1227/NEU.0b013e31820777cf

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Ghogawala, Z., Martin, B., Benzel, E. C., Dziura, J., Magge, S. N., Abbed, K. M., Bisson, E. F., Shahid, J., Coumans, J. V. C. E., Choudhri, T. F., Steinmetz, M. P., Krishnaney, A. A., King, J. T., Butler, W. E., Barker, F. G., & Heary, R. F. (2011). Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy. Neurosurgery, 68(3), 622-630. https://doi.org/10.1227/NEU.0b013e31820777cf

@article{d198067f39724be9bb65f7c7e86d1731,

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. 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.",

keywords = "Cervical spondylotic myelopathy, Clinical trial, Cost-effectiveness analysis, Outcomes",

author = "Zoher Ghogawala and Brook Martin and Benzel, {Edward C.} and James Dziura and Magge, {Subu N.} and Abbed, {Khalid M.} and Bisson, {Erica F.} and Javed Shahid and Coumans, {Jean Valery C.E.} and Choudhri, {Tanvir F.} and Steinmetz, {Michael P.} and Krishnaney, {Ajit A.} and King, {Joseph T.} and Butler, {William E.} and Barker, {Fred G.} and Heary, {Robert F.}",

year = "2011",

month = mar,

doi = "10.1227/NEU.0b013e31820777cf",

language = "English",

volume = "68",

pages = "622--630",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Wolters Kluwer Medknow Publications",

number = "3",

}

Ghogawala, Z, Martin, B, Benzel, EC, Dziura, J, Magge, SN, Abbed, KM, Bisson, EF, Shahid, J, Coumans, JVCE, Choudhri, TF, Steinmetz, MP, Krishnaney, AA, King, JT, Butler, WE, Barker, FG & Heary, RF 2011, 'Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy', Neurosurgery, vol. 68, no. 3, pp. 622-630. https://doi.org/10.1227/NEU.0b013e31820777cf

TY - JOUR

T1 - Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy

AU - Ghogawala, Zoher

AU - Martin, Brook

AU - Benzel, Edward C.

AU - Dziura, James

AU - Magge, Subu N.

AU - Abbed, Khalid M.

AU - Bisson, Erica F.

AU - Shahid, Javed

AU - Coumans, Jean Valery C.E.

AU - Choudhri, Tanvir F.

AU - Steinmetz, Michael P.

AU - Krishnaney, Ajit A.

AU - King, Joseph T.

AU - Butler, William E.

AU - Barker, Fred G.

AU - Heary, Robert F.

PY - 2011/3

Y1 - 2011/3

N2 - 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.

AB - 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.

KW - Cervical spondylotic myelopathy

KW - Clinical trial

KW - Cost-effectiveness analysis

KW - Outcomes

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U2 - 10.1227/NEU.0b013e31820777cf

DO - 10.1227/NEU.0b013e31820777cf

M3 - Article

C2 - 21164373

AN - SCOPUS:79951772195

SN - 0148-396X

VL - 68

SP - 622

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JO - Neurosurgery

JF - Neurosurgery

IS - 3

ER -

Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy

Abstract

Keywords

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