- Ghogawala PI Cervical Spondylotic Myelopathy (CSM) represents the most common cause of spinal cord injury in the United States and has been identified by the Institute of Medicine as being among the top 100 priorities for new comparative effectiveness research. There is a significant need for new clinical trials on surgery for CSM. Surgical decompression for CSM can improve its disabling symptoms. The optimal surgical treatment, however, remains controversial, with disagreement between three main approaches: ventral decompression and fusion, dorsal decompression and fusion, or dorsal laminoplasty. Because we do not know which operation for CSM is optimal, it is likely that many patients with this disease are not receiving the best treatment. There is a growing consensus among spinal surgeons that a randomized controlled trial (RCT) comparing these three approaches is necessary, feasible, and desirable. Our objective is to obtain a conference grant with the following specific aims:
Specific Aim #1 : To convene orthopaedic and neurological spine surgeon thought leaders with representative patients with CSM and other stakeholders to inform the design of an RCT to compare the effectiveness and costs of ventral versus dorsal treatment options for treating CSM.
Specific Aim #2 : To identify and define the optimal study population for an RCT comparing ventral and dorsal surgery for CSM. The conference will be held at the Chicago Marriott O'Hare. We expect to have 12 speakers and a total of 30 attendees. At the conclusion of the conference, the ideal population for an RCT comparing ventral and dorsal surgery for treating CSM will be identified. This information will be used to finalize a protocol for an RCT comparing different treatment strategies for CSM.

Public Health Relevance

Nearly 20% of cervical spine operations in the US are performed annually to treat cervical spondylotic myelopathy (CSM), which is the most common cause of spinal cord dysfunction in the US. The objective is to hold a conference with orthopaedic and neurologic spine surgeon thought leaders from across the country to review the comparative effectiveness for different surgical treatments for CSM. Investigators will review the current evidence for the surgical management of this disorder and will reach consensus on the ideal population for an RCT comparing ventral and dorsal surgery for treating CSM.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Conference (R13)
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Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
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Panagis, James S
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Lahey Clinic
United States
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Ghogawala, Zoher; Benzel, Edward C; Riew, K Daniel et al. (2015) Surgery vs Conservative Care for Cervical Spondylotic Myelopathy: Surgery Is Appropriate for Progressive Myelopathy. Neurosurgery 62 Suppl 1:56-61
Roguski, Marie; Benzel, Edward C; Curran, Jill N et al. (2014) Postoperative cervical sagittal imbalance negatively affects outcomes after surgery for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 39:2070-7
Ghogawala, Zoher; Benzel, Edward C; Heary, Robert F et al. (2014) Cervical spondylotic myelopathy surgical trial: randomized, controlled trial design and rationale. Neurosurgery 75:334-46