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Comparison of Outcomes Following Anterior vs Posterior Fusion Surgery for Patients With Degenerative Cervical Myelopathy: An Analysis From Quality Outcomes Database.

Publication ,  Journal Article
Asher, AL; Devin, CJ; Kerezoudis, P; Chotai, S; Nian, H; Harrell, FE; Sivaganesan, A; McGirt, MJ; Archer, KR; Foley, KT; Mummaneni, PV ...
Published in: Neurosurgery
April 1, 2019

BACKGROUND: The choice of anterior vs posterior approach for degenerative cervical myelopathy that spans multiple segments remains controversial. OBJECTIVE: To compare the outcomes following the 2 approaches using multicenter prospectively collected data. METHODS: Quality Outcomes Database (QOD) for patients undergoing surgery for 3 to 5 level degenerative cervical myelopathy was analyzed. The anterior group (anterior cervical discectomy [ACDF] or corpectomy [ACCF] with fusion) was compared with posterior cervical fusion. Outcomes included: patient reported outcomes (PROs): neck disability index (NDI), numeric rating scale (NRS) of neck pain and arm pain, EQ-5D, modified Japanese Orthopedic Association score for myelopathy (mJOA), and NASS satisfaction questionnaire; hospital length of stay (LOS), 90-d readmission, and return to work (RTW). Multivariable regression models were fitted for outcomes. RESULTS: Of total 245 patients analyzed, 163 patients underwent anterior surgery (ACDF-116, ACCF-47) and 82 underwent posterior surgery. Patients undergoing an anterior approach had lower odds of having higher LOS (P < .001, odds ratio 0.16, 95% confidence interval 0.08-0.30). The 12-mo NDI, EQ-5D, NRS, mJOA, and satisfaction scores as well as 90-d readmission and RTW did not differ significantly between anterior and posterior groups. CONCLUSION: Patients undergoing anterior approaches for 3 to 5 level degenerative cervical myelopathy had shorter hospital LOS compared to those undergoing posterior decompression and fusion. Also, patients in both groups exhibited similar long-term PROs, readmission, and RTW rates. Further investigations are needed to compare the differences in longer term reoperation rates and functional outcomes before the clinical superiority of one approach over the other can be established.

Duke Scholars

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

April 1, 2019

Volume

84

Issue

4

Start / End Page

919 / 926

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Fusion
  • Spinal Cord Diseases
  • Patient Satisfaction
  • Patient Reported Outcome Measures
  • Neurology & Neurosurgery
  • Length of Stay
  • Humans
  • Cervical Vertebrae
  • 5202 Biological psychology
 

Citation

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Asher, A. L., Devin, C. J., Kerezoudis, P., Chotai, S., Nian, H., Harrell, F. E., … Bydon, M. (2019). Comparison of Outcomes Following Anterior vs Posterior Fusion Surgery for Patients With Degenerative Cervical Myelopathy: An Analysis From Quality Outcomes Database. Neurosurgery, 84(4), 919–926. https://doi.org/10.1093/neuros/nyy144
Asher, Anthony L., Clinton J. Devin, Panagiotis Kerezoudis, Silky Chotai, Hui Nian, Frank E. Harrell, Ahilan Sivaganesan, et al. “Comparison of Outcomes Following Anterior vs Posterior Fusion Surgery for Patients With Degenerative Cervical Myelopathy: An Analysis From Quality Outcomes Database.Neurosurgery 84, no. 4 (April 1, 2019): 919–26. https://doi.org/10.1093/neuros/nyy144.
Asher AL, Devin CJ, Kerezoudis P, Chotai S, Nian H, Harrell FE, et al. Comparison of Outcomes Following Anterior vs Posterior Fusion Surgery for Patients With Degenerative Cervical Myelopathy: An Analysis From Quality Outcomes Database. Neurosurgery. 2019 Apr 1;84(4):919–26.
Asher, Anthony L., et al. “Comparison of Outcomes Following Anterior vs Posterior Fusion Surgery for Patients With Degenerative Cervical Myelopathy: An Analysis From Quality Outcomes Database.Neurosurgery, vol. 84, no. 4, Apr. 2019, pp. 919–26. Pubmed, doi:10.1093/neuros/nyy144.
Asher AL, Devin CJ, Kerezoudis P, Chotai S, Nian H, Harrell FE, Sivaganesan A, McGirt MJ, Archer KR, Foley KT, Mummaneni PV, Bisson EF, Knightly JJ, Shaffrey CI, Bydon M. Comparison of Outcomes Following Anterior vs Posterior Fusion Surgery for Patients With Degenerative Cervical Myelopathy: An Analysis From Quality Outcomes Database. Neurosurgery. 2019 Apr 1;84(4):919–926.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

April 1, 2019

Volume

84

Issue

4

Start / End Page

919 / 926

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Fusion
  • Spinal Cord Diseases
  • Patient Satisfaction
  • Patient Reported Outcome Measures
  • Neurology & Neurosurgery
  • Length of Stay
  • Humans
  • Cervical Vertebrae
  • 5202 Biological psychology