1483. Anterior vs. Posterior Cervical Decompression and Fusion in Patients with Multi-Level Degenerative Cervical Myelopathy
Authors: Jetan Badhiwala, MD; Yosef Ellenbogen; Jamie Wilson; Farshad Nassiri, MD; Christopher Witiw, MD, MS; Saleh Almenawer, MD, MSc; Michael Fehlings, MD, PhD; Jefferson Wilson, MD, PhD (Toronto, Canada)
The optimal approach for surgical decompression in degenerative cervical myelopathy (DCM) is unclear. We sought to compare the inpatient complications and costs of anterior (ACDF) versus posterior cervical decompression and fusion (PCDF) using a national administrative healthcare dataset.
Patients who underwent multi-level ACDF or PCDF for DCM were identified from the National Inpatient Sample (NIS) for 2004-2014 using ICD-9-CM codes. Propensity score matching was performed with age, sex, number and type of comorbidities, hospital bed size, and use of intra-operative monitoring as covariates. Outcomes, including hospitalization charges/costs, length of stay (LOS), discharge disposition, and inpatient complications and mortality, were compared between matched ACDF and PCDF groups.
A total of 17,805 patients were eligible. Propensity score matching resulted in a cohort of 13,884 patients (N=6,942 ACDF; N=6,942 PCDF). PCDF was associated with greater LOS (MD +1.7 days,P<0.01) and less frequent routine discharge home (OR 0.26,P<0.01). With regard to complications, the PCDF group had a higher rate of MI (OR 1.6,P<0.01), PE (OR 2.6,P<0.01), DVT (OR 3.7,P<0.01), neurological complications (OR 1.7,P<0.05), hardware-related complications (OR 2.7,P<0.01), wound infection/breakdown (OR 6.8,P<0.01), and CSF leak (OR 1.7,P<0.05). By contrast, the incidence of post-operative hematoma (OR 0.61,P<0.01), hoarseness (OR 0.13,P<0.01), and dysphagia (OR 0.20,P<0.01) were significantly lower following PCDF. Mortality rate was comparable between ACDF and PCDF (0.29% vs. 0.26%, respectively; P=0.75). Hospital charges (MD +$26,259,P<0.01) and costs (MD +$7,728,P<0.01) were significantly higher for PCDF than ACDF.
At a national level, we found anterior surgery for multi-level DCM to be associated with greater rates of post-operative hematoma, hoarseness, and dysphagia. However, posterior surgery exhibited a higher rate of general medical complications, length of stay, and in-hospital costs.