Best of the AANS Session-Discussant Early Results From The Multi-Center Prospective, Randomized CSM-S Study Overall Quality Of Life Improvement, Complications, And Heath Resource Utilization

Discussant Early Results From The Multi-Center Prospective, Randomized CSM-S Study Overall Quality Of Life Improvement, Complications, And Heath Resource Utilization

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Video Transcription

I have been asked to comment on this study. Here are my disclosures. Unique to this study was the use of an equipoise factor in which 15 surgeons determined the  suitability of each individual for enrollment in the study. The primary outcome was SF36 PCS score at one year.  Primary outcomes included NDI, EQ5, MJOA complications, return to work, and health resource utilization. The groups are comparable in preoperative demographics.  They had moderate myelopathy. As randomized, there was no significant difference in SF36 PCS scores between the ventral and dorsal surgery groups.  There was crossover, which was not explained. Looking at the cohorts as treated, laminoplasty had a statistically superior PCS score as compared to either fusion group.  There was no difference in major complications, and NDI was comparable at one year. The authors did not provide data on neck pain or MJOA improvement.  In another prospective study from the AO group, there was no statistically significant difference in SF PCS scores or complication rates between laminoplasty and dorsal fusion.  The methodology employed can produce vast differences in the absolute dollar amount for different procedures in different studies.  One way to help smooth this out is to look at the percentage difference, and when we look at the current study and compare it to another published in 2013, it is clear that  laminoplasty is roughly 50% the cost of a dorsal fusion. The study is limited by the fact that only 5 surgeons performed laminoplasty, which could produce a selection bias.  Nevertheless, it is a very important work due to the unique methodology used, which could be employed in future studies, and also the focus it places on the potential value  of laminoplasty.

Video Summary

In this video, the commentator discusses a study that uses an equipoise factor to determine the suitability of participants. The study's primary outcome was SF36 PCS score at one year, and other outcomes included NDI, EQ5, MJOA complications, return to work, and health resource utilization. The preoperative demographics were comparable between the groups, who all had moderate myelopathy. The results showed no significant difference in SF36 PCS scores between ventral and dorsal surgery groups. However, when analyzed as treated, laminoplasty had a statistically superior PCS score compared to fusion groups. The study did not provide data on neck pain or MJOA improvement. Another study found no significant difference in SF PCS scores or complication rates between laminoplasty and dorsal fusion. Comparing the current study to a previous one, laminoplasty was approximately 50% cheaper than dorsal fusion. The study had limitations, including a potential selection bias due to only five surgeons performing laminoplasty. Nonetheless, the study's unique methodology and focus on the value of laminoplasty make it important for future research.

Keywords

equipoise factor

SF36 PCS score

laminoplasty

fusion groups

selection bias