Comparative Effectiveness of Ventral vs Dorsal Surgery for Cervical Spondylotic Myelopathy

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

doi:10.1227/neu.0b013e31820777cf

Cited by 118 publications

(91 citation statements)

References 27 publications

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“…A further 65 studies were subsequently excluded for the following reasons: single level CSM (n = 14); mean cervical kyphosis [15°( n = 1); OPLL related cervical myelopathy (n = 13); combination of anterior and posterior surgical approaches used (n = 5); different surgical indications between groups (n = 7); and non-controlled studies (n = 25). Hence, a total of 8 studies were included in the meta-analysis [21][22][23][24][25][26][27][28]. The detail selection process is shown in Fig.…”

Section: Search Resultsmentioning

confidence: 99%

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Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

et al. 2013

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Purpose To compare the clinical outcomes, complications, and surgical trauma between anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. Study design Systematic review and meta-analysis. Methods We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials or non-randomized controlled trials that compared anterior and posterior surgical approaches for the treatment of multilevel cervical spondylotic myelopathy. Exclusion criteria were non-controlled studies, combined anterior and posterior surgery, follow-up \1 year, cervical kyphosis [15°, and cervical myelopathy caused by ossification of the posterior longitudinal ligament. The main end points included: recovery rate; Japanese Orthopedic Association (JOA) score; reoperation rate; complication rate; blood loss; and operation time. Subgroup analysis was conducted according to the mean number of surgical segments. Result A total of eight studies were included in the metaanalysis; none of which were randomized controlled trials. All of the selected studies were of high quality as indicated by the Newcastle-Ottawa scale. In five studies involving 351 patients, the preoperative JOA score was similar between the anterior and posterior groups [P [ 0.05, WMD: -0.00 (-0.56, 0.56)]. In four studies involving 268 patients, the postoperative JOA score was higher in the anterior group compared with the posterior group [P \ 0.05, WMD: 0.79 (0.16, 1.42)]. For recovery rate, there was significant heterogeneity among the four studies involving 304 patients, hence, only descriptive analysis was performed. In seven studies involving 447 patients, the postoperative complication rate was significant higher in the anterior group compared with the posterior group [P \ 0.05, odds ratio: 2.60 (1.63, 4.15)]. Of the 245 patients in the 8 studies who received anterior surgery, 21 (8.57 %) received reoperation. Of the 285 patients who received posterior surgery, only 1 (0.3 %) received reoperation. The reoperation rate was significantly higher in the anterior group compared with the posterior group (P \ 0.001). In the 3 studies involving 236 patients compared subtotal corpectomy and laminoplasty/laminectomy, blood loss and operation time were significantly higher in the anterior subtotal corpectomy group compared with the posterior laminoplasty/laminectomy group [P \ 0.05, WMD: 150.10 (63.53, 236.66) and P \ 0.05, WMD: 59.17 (45.69, 72.66)]. Conclusion The anterior approach was associated with better postoperative neural function than the posterior approach in the treatment of multilevel cervical spondylotic myelopathy. There was no apparent difference in the neural function recovery rate. The complication and reoperation rates were significantly higher in the anterior group compared with the posterior group. The surgical trauma associated with corpectomy was significantly higher than that associated with laminoplasty/laminectomy.

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Section: Search Resultsmentioning

confidence: 99%

“…Edwards et al [23] Ghogawala et al [26] Hirai et al [27] Kristof et al [24] Liu et al [25] Wada et al [22] Yonenobu et al [21] Total (95% CI)…”

Section: Study or Subgroupmentioning

confidence: 99%

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

et al. 2013

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“…In a recent nonrandomized prospective study, Ghogawala et al [13] reported no difference in terms of functional recovery between patients who underwent anterior or posterior approach. The postoperative mJOA scores in both groups were nearly two points better compared with the preoperative mJOA scores (from 11.60 to 13.54 in the posterior group and from 13.40 to 15.44 in the anterior group).…”

Section: Clinical Improvementmentioning

confidence: 96%

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Zaïri

Aboukaïs²,

Thines³

et al. 2012

Eur Spine J

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Background In patients with cervical spondylotic myelopathy, ventral disease and loss of physiological cervical lordosis are indications for anterior approach. As bone graft and titanium cage present many drawbacks, expandable titanium cage has been recently introduced for this indication. The authors present the clinical and radiological outcomes in patients undergoing the placement of an expandable cage in the treatment of spondylotic myelopathy with straight or kyphotic cervical spine alignment. Methods This was a retrospective review of prospectively collected data. A total of 26 patients underwent cervical corpectomy and reconstruction using an expandable titanium cage and anterior plate between 2005 and 2008. Pain and functional disability were measured using VAS and mJOA preoperatively and at 3 months, 6 months, 1 year and 2 years. Kyphosis was measured using lateral radiographs at the same points of follow-up. Fusion was evaluated on flexion-extension radiographs at 2 years. Results The mean VAS improved from 4.2 to 1.7 and the mean mJOA increased from 12.85 to 16.04 at 2 years postoperatively (p \ 0.05). The mean kyphosis angle decreased from 17°to 2°at the last follow-up (p \ 0.05). The fusion rate was 100 % at 2 years. Three complications were reported including a transient dysphagia, an epidural hematoma and an early hardware migration.Conclusion Expandable titanium cage is an effective device, which achieves good clinical and radiological outcomes at a minimum 2-year follow-up.

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“…A ventral approach allows for direct decompression of ventral pathological entities in kyphotic, neutral, or lordotic spines, and avoids the pain associated with a posterior paraspinal musculature stripping approach, but is associated with its own compli cations including dysphagia, hoarseness, and cardiopul monary events. 1,4,5,10,21 Traditional postoperative outcome measures such as complications, readmission rates, revision surgery rates, and return to work measures do not fully encompass the patient experience following surgery and the relative ad vantages and disadvantages of each of the approaches. Recent studies have increasingly investigated financial cost and QOL outcomes for these 2 surgeries.…”

mentioning

confidence: 99%

“…Recent studies have increasingly investigated financial cost and QOL outcomes for these 2 surgeries. 1,3,5,9,22 Despite the numerous studies on this topic, uncer tainty remains about which of the 2 procedures is optimal for the treatment of CSM. Previous reviews on the topic, including one in this journal, 13 have attempted to address this uncertainty by using physiological parameters and other preoperative factors that may aid in the selection of the optimal surgical approach.…”

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confidence: 99%

Ventral fusion versus dorsal fusion: determining the optimal treatment for cervical spondylotic myelopathy

Alvin

Lubelski

Benzel

et al. 2013

FOC

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Cervical spondylotic myelopathy (CSM) often can be surgically treated by either ventral or dorsal decompression and fusion. However, there is a lack of high-level evidence on the relative advantages and disadvantages for these treatments of CSM. The authors' goal was to provide a comprehensive review of the relative benefits of ventral versus dorsal fusion in terms of quality of life (QOL) outcomes, complications, and costs. They reviewed 7 studies on CSM published between 2003 and 2013 and summarized the findings for each category. Both procedures have been shown to lead to statistically significant improvement in clinical outcomes for patients. Ventral fusion surgery has been shown to yield better QOL outcomes than dorsal fusion surgery. Complication rates for ventral fusion surgery range from 11% to 13.6%, whereas those for dorsal fusion surgery range from 16.4% to 19%. Larger randomized controlled trials are needed, with particular emphasis on QOL and minimum clinically important differences.

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Comparative Effectiveness of Ventral vs Dorsal Surgery for Cervical Spondylotic Myelopathy

Cited by 118 publications

References 27 publications

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Ventral fusion versus dorsal fusion: determining the optimal treatment for cervical spondylotic myelopathy

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