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

Alvin, Matthew D.; Lubelski, Daniel; Benzel, Edward C.; Mroz, Thomas E.

doi:10.3171/2013.4.focus13103

Cited by 11 publications

(18 citation statements)

References 25 publications

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“…Far fewer studies have been published on PCF outcomes than on ACF outcomes (especially anterior cervical discectomy and fusion outcomes), most likely because far fewer PCFs than ACFs are performed [1,4−6]. Posterior cervical fusion patient-reported outcomes, as well as complication and reoperation rates, have been assembled mostly in review articles from studies that compared PCF (laminectomy and fusion) with laminoplasty [7−12] or PCF with ACF [13]. A systematic review, published in 2009, of 11 studies on cervical laminectomy and fusion reported on patients' improvement in neurologic function and in Japanese Orthopaedic Association (JOA) score [14].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis

Youssef

Heiner

Montgomery³

et al. 2019

The Spine Journal

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BACKGROUND CONTEXT: Posterior cervical fusion (PCF) with decompression is a treatment option for patients with conditions such as spondylosis, spinal stenosis, and degenerative disc disorders that result in myelopathy or radiculopathy. The annual rate, number, and cost of PCF in the United States has increased. Far fewer studies have been published on PCF outcomes than on anterior cervical fusion (ACF) outcomes, most likely because far fewer PCFs than ACFs are performed. PURPOSE: To evaluate the patient-reported and clinical outcomes of adult patients who underwent subaxial posterior cervical fusion with decompression. STUDY DESIGN/SETTING: Systematic review and meta-analysis. PATIENT SAMPLE: The total number of patients in the 31 articles reviewed and included in the meta-analysis was 1,238 (range 7−166). OUTCOME MEASURES: Preoperative to postoperative change in patient-reported outcomes (visual analog scales for arm pain and neck pain, Neck Disability Index, Japanese Orthopaedic Association [JOA] score, modified JOA score, and Nurick pain scale) and rates of fusion, revision, and complications or adverse events. METHODS: This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a preapproved protocol. PubMed and Embase databases were searched for articles published from January 2001 through July 2018. Statistical analyses for patient-reported outcomes were performed on the outcomes' raw mean differences, calculated as postoperative value minus preoperative value from each study. Pooled rates of successful fusion, revision surgery, and complications or adverse events, and their 95% confidence FDA device/drug status: Not applicable.

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Section: Introductionmentioning

confidence: 99%

Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis

Youssef

Heiner

Montgomery³

et al. 2019

The Spine Journal

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“…[9] However, a recent review by Alvin et al found that many cost studies in the ACF-PCF comparison literature fail to adequately include indirect costs in their analyses. [2] Despite this limitation, Alvin et al conclude that both dorsal and ventral decompression and fusion, when used to treat CSM, can lead to significant improvements in quality of life (QOL). Still, uncertainty remains about which of the two approaches is preferred in the treatment of CSM.…”

Section: Discussionmentioning

confidence: 99%

“…Although complications such as dysphagia and dysphonia are more common in ACF, the procedure enables direct decompression of cervical pathologies in kyphotic, neutral, or lordotic alignment. While PCF can be used in patients with neutral or lordotic spinal alignment, [2] it can lead to significant postoperative muscle pain. [3–6] …”

Section: Introductionmentioning

confidence: 99%

Propensity-matched Analysis of Outcomes and Hospital Charges for Anterior Versus Posterior Cervical Fusion for Cervical Spondylotic Myelopathy

Tanenbaum

Lubelski

Rosenbaum

et al. 2017

Clinical Spine Surgery: A Spine Publication

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STUDY DESIGN Retrospective analysis of data from the Nationwide Inpatient Sample (NIS), a nationally representative, all-payer database of inpatient diagnoses and procedures in the United States. OBJECTIVE The objective of this study is to compare anterior cervical fusion (ACF) to posterior cervical fusion (PCF) in the treatment of cervical spondylotic myelopathy (CSM). SUMMARY of BACKGROUND DATA Previous studies used retrospective single-institution level data to quantify outcomes for CSM patients undergoing cervical fusion. It is unclear whether ACF or PCF is superior with regards to charges or outcomes for the treatment of CSM. METHODS We used NIS data to compare ACF to PCF in the management of CSM. All patients 18 years or older with a diagnosis of CSM between 1998–2011 were included. ACF patients were matched to PCF patients using propensity scores based on patient characteristics (number of levels fused, spine alignment, comorbidities), hospital characteristics, and patient demographics. Multivariable regression was used to measure the effect of treatment assignment on in-hospital charges, length of hospital stay, in-hospital mortality, discharge disposition, and dysphagia diagnosis. RESULTS From 1998–2011, we identified 109,728 hospitalizations with a CSM diagnosis. Of these patients, 45,629 (41.6%) underwent ACF and 14,439 (13.2%) underwent PCF. The PCF cohort incurred an average of $41,683 more in-hospital charges (p<0.001, inflation adjusted to 2011 dollars) and remained in hospital an average of 2.4 days longer (p<0.001) than the ACF cohort. The ACF cohort was just as likely to die in the hospital (OR 0.91, 95% CI 0.68–1.2), 3.0 times more likely to be discharged to home or self-care (95% CI 2.9–3.2), and 2.5 times more likely to experience dysphagia (95% CI 2.0–3.1) than the PCF cohort. CONCLUSIONS In treating CSM, ACF led to lower hospital charges, shorter hospital stays, and an increased likelihood of being discharged to home relative to PCF.

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“…Bu cerrahi hedefler servikal omurgaya çeşitli cerrahi yaklaşım yolları kullanılarak sağlanabilir 3,4 . SSMR cerrahisi sonrası geç dönem nörolojik tabloda bozulmanın en önemli sebepleri instabilite, servikal dizilimde bozulma ve komşu segment hastalığıdır.İnstabilite ve servikal dizilimde bozulma posterior cerrahi yaklaşımları takiben daha sık karşımıza çıkan bir problemdir.Komşu segment hastalığı ise literatürde aksini bildiren yayınlar olmakla birlikte anterior cerrahi yaklaşımları takiben daha sık karşılaşıldığı söylenebilir [3][4][5][6][7][8][9] .…”

Section: Introductionunclassified

Servikal Spondilotik Myeloradikülopati"nin Cerrahi Tedavisinde Anterior Yaklaşımın Seçilme Nedenleri

Gezercan¹,

Özsoy²,

Çetinalp³

et al. 2014

Cukurova Medical Journal

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ÖZETServikal spondilosis; servikal intervertebral diskte başlayıp, daha sonra çevre kemik ve yumuşak dokularda devam eden, ilerleyici, süreğen ve sinsi bir dejeneratif hastalıktır. Bu dejeneratif değişikliklere bağlı omurilik ve sinir kökü tutulumu olur ise servikal spondilotik myeloradikülopati (SSMR) olarak isimlendirilir ve 50 yaş üzerinde myelopatinin en sık sebebidir.İlerleyici ve fonksiyonel nörolojik defisite sahip olan olgular ile uzun süreli tanı almış ve konservatif tedaviye yanıt vermeyen yakınmaları bulunan olguların cerrahi olarak tedavi edilmeleri gerekir. Cerrahi tedavinin amacı omurilik ve sinir kökleri üzerindeki basıyı ortadan kaldırmak, servikal omurganın dizilimini korumak veya bozulmuş ise bunu yeniden oluşturmak, hastanın nörolojik bulgularını ve yakınmalarını ortadan kaldırarak yaşam kalitesini artırmak ve bunları yaparken de mümkün olduğu kadar komplikasyona neden olmamaktır. Bu hedefler servikal omurgaya anterior veya posterior cerrahi yaklaşım yolları ile sağlanabilir.Cerrahi yaklaşımın şekline ancak hastanın klinik ve radyolojik olarak çok ayrıntılı değerlendirilmesi ile karar verilebilir.Cerrahi yaklaşımın en büyük amacı olan yeterli nöral dekompresyon ve servikal dizilimin korunması/sağlanması en iyi anterior yaklaşımlar ile sağlanabilir.Bu çalışmamızda SSMR'nin cerrahi tedavisinde anterior yaklaşımın tercih edilme sebepleri özetlenecektir. Key Words: Servikal, spondilosis, cerrahi tedavi, anterior yaklaşım, posterior yaklaşım. ABSTRACTCervical spondylosis is a progressive, chronic and insidious degenerative disease, which origins from the cervical intervertebral disc and then diffuses to surrounding bony and soft tissues. If the spine and nerve roots are involved due to degenerative changes, this is called as cervical spondylotic myeloradiculopathy (CSMR) and it is the most frequent cause of myelopathy over age of 50. Cases with progressive character and functional neurological deficits and cases with a prolonged course refractory to conservative therapy shall be treated surgically. The aim of the surgical treatment is to relieve the pressure on the spinal cord and nerve roots, to preserve the proper anatomical alignment of the cervical vertebrae or to reestablish correct anatomical positioning if it is distorted and lastly to increase the life quality by relieving patients neurological signs and complaints. While achieving these goals, complications shall be avoided as much as possible. These goals can be accomplished by anterior or posterior surgical approaches to the cervical vertebrae. The style of the surgical approach can only be decided by a detailed evaluation of the patient's clinical and radiological features. The utmost aim of the surgical procedure, which is to achieve sufficient neurological decompression and to preserve/establish proper cervical vertebral alignment, can be provided best by anterior approaches. In our current study, the criteria to prefer anterior approach in surgical treatment of CSMR will be reviewed. Anahtar Kelimeler:Cervical, spondylosis, surgical ...

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

Cited by 11 publications

References 25 publications

Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis

Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis

Propensity-matched Analysis of Outcomes and Hospital Charges for Anterior Versus Posterior Cervical Fusion for Cervical Spondylotic Myelopathy

Servikal Spondilotik Myeloradikülopati"nin Cerrahi Tedavisinde Anterior Yaklaşımın Seçilme Nedenleri

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