Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 1;34(7):E425-E431.
doi: 10.1097/BSD.0000000000001209.

Comparison of Perioperative Complications in Anterior Decompression With Fusion and Posterior Decompression With Fusion for Cervical Spondylotic Myelopathy: Propensity Score Matching Analysis Using a Nationwide Inpatient Database

Shingo Morishita  1 , Toshitaka Yoshii  1 , Hiroyuki Inose  1 , Takashi Hirai  1 , Masato Yuasa  1 , Yu Matsukura  1 , Takahisa Ogawa  1 , Kiyohide Fushimi  2 , Atsushi Okawa  1 , Takeo Fujiwara  3
Affiliations

Comparison of Perioperative Complications in Anterior Decompression With Fusion and Posterior Decompression With Fusion for Cervical Spondylotic Myelopathy: Propensity Score Matching Analysis Using a Nationwide Inpatient Database

Shingo Morishita et al. Clin Spine Surg. .

Abstract

Study design: A retrospective cohort study with a national inpatient database.

Objective: This study aimed to research the perioperative complication rates of cervical spondylotic myelopathy (CSM) patients who underwent anterior decompression with fusion (ADF) and posterior decompression with fusion (PDF) using a large national inpatient database and propensity score matching (PSM) analysis.

Summary of background data: There are several ways to successfully achieve surgical spinal decompression in CSM patients; however, evidence of the systemic complications and reoperation rates in ADF and PDF is lacking.

Materials and methods: We identified patients who were hospitalized for CSM and underwent either ADF or PDF from 2010 to 2016 using the Japanese Diagnosis Procedure Combination database. In the ADF and PDF groups, we compared postoperative complications (systemic and local), medical costs during hospitalization, and mortality before and after PSM. In addition, multivariate regression analysis was performed to identify risk factors for perioperative systemic complications.

Results: A total of 1013 matched pairs were made after PSM. More perioperative systemic complications were detected in the ADF group than in the PDF group (at least 1 complication: ADF vs. PDF: 15.2% vs. 12.0%, P=0.038), especially for respiratory failure (1.4% vs. 0.4%, P=0.018), pneumonia (1.9% vs. 0.5%, P=0.004), and dysphagia (3.0% vs. 1.1%, P=0.003). The costs were ~$8000 higher (P<0.001) and the length of hospital stay was almost 5 days longer (P<0.001) in the PDF group. The risk factors for perioperative systemic complications in ADF were high age, low body mass index, and preoperative respiratory disease, and the factors in PDF were high body mass index and preoperative renal disease.

Conclusion: More systemic complications, especially respiratory events, were more frequently observed in the ADF group, while the medical costs were higher and the hospital stay was longer in the PDF group.

Level of evidence: Level III.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Similar articles

See all similar articles

Cited by

References

    1. Nouri A, Cheng JS, Davies B, et al. Degenerative cervical myelopathy: a brief review of past perspectives, present developments, and future directions. J Clin Med. 2020;9:535.
    1. Hori M, Hagiwara A, Fukunaga I, et al. Application of quantitative microstructural MR imaging with atlas-based analysis for the spinal cord in cervical spondylotic myelopathy. Sci Rep. 2018;8:5213.
    1. Hartig D, Batke J, Dea N, et al. Adverse events in surgically treated cervical spondylopathic myelopathy: a prospective validated observational study. Spine (Phila Pa 1976). 2015;40:292–298.
    1. Fehlings MG, Wilson JR, Kopjar B, et al. Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy results of the AOSpine North America prospective multi-center study. J Bone Joint Surg Am. 2013;95:1651–1658.
    1. Nakashima H, Kanemura T, Satake K, et al. Reoperation for late neurological deterioration after laminoplasty in individuals with degenerative cervical myelopathy: comparison of cases of cervical spondylosis and ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976). 2020;45:E909–E916.

Publication types