Effect of Ventral vs Dorsal Spinal Surgery in Patients With
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According to a JAMA study, among patients with cervical spondylotic myelopathy undergoing cervical spinal surgery, a ventral approach did not significantly improve patient-reported physical functioning at 1 year compared with outcomes after a dorsal approach.

Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction worldwide. The objective of this study was to determine whether a ventral surgical approach compared with a dorsal surgical approach for the treatment of cervical spondylotic myelopathy improves patient-reported physical functioning at 1 year.

A randomized clinical trial of patients aged 45 to 80 years with multilevel cervical spondylotic myelopathy enrolled at 15 large North American hospitals was carried out. 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. The type of dorsal surgery (fusion or laminoplasty) was at the surgeon’s discretion.

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. One-year SF-36 PCS mean improvement was not significantly different between ventral surgery and dorsal surgery. 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.

Conclusively, in 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.

Source: https://jamanetwork.com/journals/jama/article-abstract/2777236
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