Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study

Presented at the 2011 Spine Section Meeting 

Michael G. Fehlings Department of Neurosurgery, University of Toronto, Ontario, Canada;

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Justin S. Smith Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;

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Branko Kopjar Departments of Health Services and

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Paul M. Arnold Department of Neurosurgery, University of Kansas, Kansas City, Kansas;

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S. Tim Yoon Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia;

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Alexander R. Vaccaro Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania;

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Darrel S. Brodke Department of Orthopaedics, University of Utah, Salt Lake City, Utah;

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Michael E. Janssen Center for Spinal Disorders, Spine Education and Research Institute, Denver, Colorado;

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Jens R. Chapman Orthopaedics, University of Washington, Seattle, Washington;

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Rick C. Sasso Department of Orthopedic Surgery, Indiana Spine Group, Indianapolis, Indiana;

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Eric J. Woodard Department of Orthopedic Surgery, New England Baptist Hospital, Boston;

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Robert J. Banco Boston Spine Group, Newton, Massachusetts;

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Eric M. Massicotte Department of Neurosurgery, University of Toronto, Ontario, Canada;

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Mark B. Dekutoski Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota;

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Ziya L. Gokaslan Department of Neurosurgery, Spine Division, Johns Hopkins University, Baltimore, Maryland; and

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Christopher M. Bono Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts

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Christopher I. Shaffrey Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;

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Object

Rates of complications associated with the surgical treatment of cervical spondylotic myelopathy (CSM) are not clear. Appreciating these risks is important for patient counseling and quality improvement. The authors sought to assess the rates of and risk factors associated with perioperative and delayed complications associated with the surgical treatment of CSM.

Methods

Data from the AOSpine North America Cervical Spondylotic Myelopathy Study, a prospective, multicenter study, were analyzed. Outcomes data, including adverse events, were collected in a standardized manner and externally monitored. Rates of perioperative complications (within 30 days of surgery) and delayed complications (31 days to 2 years following surgery) were tabulated and stratified based on clinical factors.

Results

The study enrolled 302 patients (mean age 57 years, range 29–86) years. Of 332 reported adverse events, 73 were classified as perioperative complications (25 major and 48 minor) in 47 patients (overall perioperative complication rate of 15.6%). The most common perioperative complications included minor cardiopulmonary events (3.0%), dysphagia (3.0%), and superficial wound infection (2.3%). Perioperative worsening of myelopathy was reported in 4 patients (1.3%). Based on 275 patients who completed 2 years of follow-up, there were 14 delayed complications (8 minor, 6 major) in 12 patients, for an overall delayed complication rate of 4.4%. Of patients treated with anterior-only (n = 176), posterior-only (n = 107), and combined anterior-posterior (n = 19) procedures, 11%, 19%, and 37%, respectively, had 1 or more perioperative complications. Compared with anterior-only approaches, posterior-only approaches had a higher rate of wound infection (0.6% vs 4.7%, p = 0.030). Dysphagia was more common with combined anterior-posterior procedures (21.1%) compared with anterior-only procedures (2.3%) or posterior-only procedures (0.9%) (p < 0.001). The incidence of C-5 radiculopathy was not associated with the surgical approach (p = 0.8). The occurrence of perioperative complications was associated with increased age (p = 0.006), combined anterior-posterior procedures (p = 0.016), increased operative time (p = 0.009), and increased operative blood loss (p = 0.005), but it was not associated with comorbidity score, body mass index, modified Japanese Orthopaedic Association score, smoking status, anterior-only versus posterior-only approach, or specific procedures. Multivariate analysis of factors associated with minor or major complications identified age (OR 1.029, 95% CI 1.002–1.057, p = 0.035) and operative time (OR 1.005, 95% CI 1.002–1.008, p = 0.001). Multivariate analysis of factors associated with major complications identified age (OR 1.054, 95% CI 1.015–1.094, p = 0.006) and combined anterior-posterior procedures (OR 5.297, 95% CI 1.626–17.256, p = 0.006).

Conclusions

For the surgical treatment of CSM, the vast majority of complications were treatable and without long-term impact. Multivariate factors associated with an increased risk of complications include greater age, increased operative time, and use of combined anterior-posterior procedures.

Abbreviations used in this paper:

BMI = body mass index; CSM = cervical spondylotic myelopathy; mJOA = modified Japanese Orthopaedic Association.
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