Dorsal Spinal Surgery was more effective on physical Functio
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Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction worldwide. A Study was conducted 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.

Randomized clinical trial was done of patients aged 45 to 80 years with multilevel cervical spondylotic myelopathy. 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.

The primary outcome was 1-year change in the Short Form 36 physical component summary (SF-36 PCS) score. 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.

--Among 163 patients who were randomized, 155 completed the trial at 1 year.

--All patients had surgery, but 5 patients did not receive their allocated surgery (ventral: n=1; dorsal: n=4).

--1 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).

--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% and included dysphagia, new neurological deficit, reoperations, and readmissions within 30 days.

In conclusion, a ventral surgical approach did not substantially increase patient-reported physical functioning at 1 year relative to results after a dorsal surgical approach in patients with cervical spondylotic myelopathy undergoing cervical spinal surgery.