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Comment & Response
July 27, 2021

Effect of Ventral vs Dorsal Spinal Surgery in Patients With Cervical Spondylotic Myelopathy

Author Affiliations
  • 1Department of Orthopedic and Trauma Research, Tokyo Medical and Dental University, Tokyo, Japan
  • 2Department of Orthopedics, Tokyo Medical and Dental University, Tokyo, Japan
JAMA. 2021;326(4):357-358. doi:10.1001/jama.2021.7262

To the Editor We have several concerns about the recent study on the effect of ventral vs dorsal spinal surgery in patients with cervical spondylotic myelopathy.1 First, fusion is not always necessary after dorsal decompression if the vertebral disk and facet joints are maintained. In a Japanese survey from 2011, decompression alone was performed in 89.4% of surgeries for cervical spondylotic myelopathy.2 While additional fusion is necessary with cervical kyphosis or instability, an assessment of cervical instability was not specified in the study by Dr Ghogawala and colleagues.1 Moreover, although exclusion criteria in their prior study included C2 to C7 kyphosis greater than 5° as measured on a plain film radiograph in extension,3 the current study excluded C2 to C7 kyphosis greater than 5° as measured on a standing cervical lateral radiograph. We hope the authors can clarify whether cervical kyphosis was assessed in extension because it is usually assessed on cervical neutral lateral radiographs in the free-standing position.

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