The purpose of the study is to determine the best surgical approach for subjects who have spinal cord problems caused by pressure from arthritic changes in the neck.
Surgical decompression for CSM can improve its disabling symptoms, but surgical complications are common and many of these complications affect patients' overall health-related quality of life. The optimal surgical treatment, therefore, remains controversial, with disagreement between three main approaches: ventral decompression and fusion, dorsal decompression and fusion, or dorsal laminoplasty. This study aims to test the hypothesis that ventral surgery is associated with superior SF-36 PCS outcome at one year follow-up compared to dorsal approaches and that both ventral and dorsal surgery improve symptoms of spinal cord dysfunction using the mJOA score. A secondary hypothesis is that health resource utilization for ventral surgery, dorsal fusion, and laminoplasty surgery are different. A third hypothesis is that cervical sagittal balance post-operatively is a significant predictor of SF-36 PCS outcome.
Patients aged 45-80 years with CSM ( ≥2 levels of spinal cord compression from C3 to C7) presenting with ≥2 of the following symptoms/signs: clumsy hands, gait disturbance, hyperreflexia, up going toes, bladder dysfunction, or ankle clonus
Any of the following: C2-C7 kyphosis>5º (measured in extension), segmental kyphotic deformity (defined by ≥3 osteophytes extending dorsal to a C2-C7 dorsal-caudal line measured on cervical spine CT), ossification of posterior longitudinal ligament (OPLL - measured on cervical spine CT), developmental narrow canal (12 mm anterior-posterior canal diameter at the base of C2 measured on cervical spine radiograph), previous cervical spine surgery, or significant active health-related co-morbidity (Anesthesia Class III or higher).