Comparative Effectiveness of Ventral vs Dorsal Surgery for Cervical Spondylotic Myelopathy

被引：107

作者：

Ghogawala, Zoher ^{[1
,2
,3
]}

Martin, Brook ^{[5
]}

Benzel, Edward C. ^{[6
,7
]}

Dziura, James ^{[4
]}

Magge, Subu N. ^{[8
]}

Abbed, Khalid M. ^{[2
,3
]}

Bisson, Erica F. ^{[9
]}

Shahid, Javed ^{[10
]}

Coumans, Jean-Valery C. E. ^{[11
]}

Choudhri, Tanvir F. ^{[12
]}

Steinmetz, Michael P. ^{[6
,7
]}

Krishnaney, Ajit A. ^{[6
,7
]}

King, Joseph T., Jr. ^{[13
]}

Butler, William E. ^{[11
]}

Barker, Fred G., II ^{[11
]}

Heary, Robert F. ^{[14
]}

机构：

[1] Yale Univ, Wallace Clin Trials Ctr, Sch Med, Greenwich Hosp, Greenwich, CT 06830 USA

[2] Connecticut Spine Inst, Greenwich, CT USA

[3] Yale Univ, Sch Med, Dept Neurosurg, New Haven, CT USA

[4] Yale Univ, Sch Med, Yale Ctr Clin Invest, New Haven, CT USA

[5] Dartmouth Coll, Hanover, NH 03755 USA

[6] Cleveland Clin Fdn, Ctr Spine Hlth, Cleveland, OH 44195 USA

[7] Cleveland Clin Fdn, Dept Neurosurg, Cleveland, OH 44195 USA

[8] Lahey Clin Fdn, Dept Neurosurg, Burlington, MA USA

[9] Univ Utah, Hlth Sci Ctr, Dept Neurosurg, Salt Lake City, UT USA

[10] Danbury Hosp, Dept Neurosurg, Danbury, CT USA

[11] Massachusetts Gen Hosp, Dept Neurosurg, Boston, MA 02114 USA

[12] Mt Sinai Hosp, Dept Neurosurg, New York, NY 10029 USA

[13] VA Connecticut Healthcare Syst, Neurosurg Sect, West Haven, CT USA

[14] Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Neurosurg, Newark, NJ 07103 USA

来源：

NEUROSURGERY | 2011年 / 68卷 / 03期

基金：

美国国家卫生研究院;

关键词：

Cervical spondylotic myelopathy; Clinical trial; Cost-effectiveness analysis; Outcomes; SURGICAL-TREATMENT; HEALTH-CARE; CONTROLLED-TRIAL; NATIONAL TRENDS; SPINAL-FUSION; CORPECTOMY; COMPLICATIONS; DECOMPRESSION; OUTCOMES; GRAFT;

D O I：

10.1227/NEU.0b013e31820777cf

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：622 / 630

页数：9

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