Abstract and Introduction
Abstract
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.
Introduction
Cervical spondylotic myelopathy can be surgically treated by a variety of techniques, including both ventral and dorsal decompression with fusion. The ventral approach refers to multilevel discectomy and/or corpectomy with instrumented fusion, whereas the dorsal approach refers to midline cervical laminectomy and fusion. Each of these approaches has unique advantages and disadvantages. Although a dorsal approach is technically easier and avoids the morbidity associated with a ventral approach, it can cause significant postoperative muscular pain and is limited to patients who have either neutral or lordotic alignment. 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 complications including dysphagia, hoarseness, and cardiopulmonary events.
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 advantages and disadvantages of each of the approaches. Recent studies have increasingly investigated financial cost and QOL outcomes for these 2 surgeries.
Despite the numerous studies on this topic, uncertainty remains about which of the 2 procedures is optimal for the treatment of CSM. Previous reviews on the topic, including one in this journal, 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. Decision-making algorithms have also been suggested based on the location of the stenosis and alignment of the cervical spine.
This review presents the state of the literature regarding the comparative effectiveness of ventral multilevel discectomy and fusion as opposed to dorsal fusion surgery for treating CSM. We summarize the recent studies comparing the 2 procedures based on QOL outcomes, postoperative complication profiles, and cost-effectiveness. This review seeks to provide a comprehensive guide to the published evidence comparing ventral multilevel discectomy and fusion to dorsal fusion for surgical treatment of CSM.