A comparison of the perioperative outcomes of anterior surgical techniques for the treatment of multilevel degenerative cervical myelopathy

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  • Division of Neurosurgery and Spinal Program, Department of Surgery, University of Toronto, Ontario, Canada
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OBJECTIVE

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Multilevel ventral compressive pathology is routinely managed through anterior decompression and reconstruction, but there remains uncertainty regarding the relative safety and efficacy of multiple discectomies, multiple corpectomies, or hybrid corpectomy-discectomy. To that end, using a large national administrative healthcare data set, the authors sought to compare the perioperative outcomes of anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and hybrid corpectomy-discectomy for multilevel DCM.

METHODS

Patients with a primary diagnosis of DCM who underwent an elective anterior cervical decompression and reconstruction operation over 3 cervical spinal segments were identified from the 2012–2017 National Surgical Quality Improvement Program database. Patients were separated into those undergoing 3-level discectomy, 2-level corpectomy, or a hybrid procedure (single-level corpectomy plus additional single-level discectomy). Outcomes included 30-day mortality, major complication, reoperation, and readmission, as well as operative duration, length of stay (LOS), and routine discharge home. Outcomes were compared between treatment groups by multivariable regression, adjusting for age and comorbidities (modified Frailty Index). Effect sizes were reported by adjusted odds ratio (aOR) or mean difference (aMD) and associated 95% confidence interval.

RESULTS

The study cohort consisted of 1298 patients; of these, 713 underwent 3-level ACDF, 314 2-level ACCF, and 271 hybrid corpectomy-discectomy. There was no difference in 30-day mortality, reoperation, or readmission among the 3 procedures. However, on both univariate and adjusted analyses, compared to 3-level ACDF, 2-level ACCF was associated with significantly greater risk of major complication (aOR 2.82, p = 0.005), longer hospital LOS (aMD 0.8 days, p = 0.002), and less frequent discharge home (aOR 0.59, p = 0.046). In contrast, hybrid corpectomy-discectomy had comparable outcomes to 3-level ACDF but was associated with significantly shorter operative duration (aMD −16.9 minutes, p = 0.002).

CONCLUSIONS

The authors found multiple discectomies and hybrid corpectomy-discectomy to have a comparable safety profile in treating multilevel DCM. In contrast, multiple corpectomies were associated with a higher complication rate, longer hospital LOS, and lower likelihood of being discharged directly home from the hospital, and may therefore be a higher-risk operation.

ABBREVIATIONS ACCF = anterior cervical corpectomy and fusion; ACDF = anterior cervical discectomy and fusion; aMD = adjusted mean difference; aOR = adjusted odds ratio; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; CPT = Current Procedural Terminology; DCM = degenerative cervical myelopathy; DVT = deep vein thrombosis; ICD-9/10-CM = International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification; LOS = length of stay; MI = myocardial infarction; mJOA = modified Japanese Orthopaedic Association; NSQIP = National Surgical Quality Improvement Program; PE = pulmonary embolism.

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Contributor Notes

Correspondence Michael G. Fehlings: University of Toronto, Toronto Western Hospital, Toronto, ON, Canada. michael.fehlings@uhn.ca.

INCLUDE WHEN CITING Published online June 12, 2020; DOI: 10.3171/2020.4.SPINE191094.

Disclosures Dr. Jefferson Wilson reports being a consultant for Stryker Canada and Bioventus.

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