Effect of Ventral vs Dorsal Spinal Surgery on Patient-Reported Physical Functioning in Patients With Cervical Spondylotic Myelopathy: A Randomized Clinical Trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(6):50 JAMA. 2021 Mar 9;325(10):942-951.What this means for my practice?
Clinicians should remember that ventral and dorsal spinal surgeries offer similar functional improvement at 1 year for cervical spondylotic myelopathy, but ventral surgery is associated with more complications. These findings support a tailored approach to surgical planning. However, the study was limited by non-random allocation within dorsal subtypes and potential selection bias.
Study Summary
One hundred sixty-three patients with multilevel cervical spondylotic myelopathy were randomized to receive either ventral decompression and fusion (n=63) or dorsal surgery (laminectomy with fusion or laminoplasty, n=100). The primary outcome was the change in the SF-36 physical component summary (PCS) score at 1 year. Secondary outcomes included changes in the modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), EuroQol-5D (EQ-5D), complication rates, work status, sagittal alignment, and healthcare resource use, assessed up to 2 years. Overall, the results revealed no significant difference in the 1-year improvement in SF-36 PCS scores between the ventral (5.9 points) and dorsal (6.2 points) groups. Complication rates were significantly higher in the ventral group. The study suggests both approaches lead to meaningful functional improvements, but ventral surgery carries a higher risk of complications.
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