To the Editor The recently published CSM-S trial1 demonstrated that both ventral and dorsal surgical approaches performed equally well in patients with cervical spondylotic myelopathy. We have several comments about this study. First, while Dr Ghogawala and colleagues have used randomized clinical trials comparing the ventral and dorsal approaches,2-4 they refined the eligibility criteria to a patient population suitable for either surgical approach. The careful selection of patients provided clinical equipoise but also reduces the generalizability of their findings.1 For patients who met the study inclusion criteria, patient-reported physical functioning at 1 year was similar with the ventral and dorsal surgical approaches. However, a dorsal approach is often preferred if there is ossification of the posterior longitudinal ligament with preserved cervical lordosis or multilevel compression from predominantly dorsal pathology. A ventral approach is more suitable for cervical lordosis or predominantly ventral compressive pathology over a limited number of vertebral segments.
Shao L, Wu X, Huang W. Effect of Ventral vs Dorsal Spinal Surgery in Patients With Cervical Spondylotic Myelopathy. JAMA. 2021;326(4):358. doi:10.1001/jama.2021.7265
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