- Email: [email protected]
Observed Patterns of Cervical Radiculopathy: How Often Do They Differ from a Standard, “Netter-Diagram” Distribution?
NASS 32nd Annual Meeting Proceedings / The Spine Journal 17 (2017) S111–S165 cases, varying with spinal region and ventilator parameters. Respiration-induced motion is significantly underestimated in this study. These errors should be compensated for in image-guidance systems to minimize navigation inaccuracy. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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tervention to resolve adverse changes in neurophysiologic function and help mitigate evolving neurologic injury. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.07.292
https://doi.org/10.1016/j.spinee.2017.07.291
239. Neurologic Complications May Occur During Any Stage of Extradural Spine Surgery: Intraoperative Neuromonitoring Findings and Outcomes in 107,447 Procedures Anthony K. Sestokas, PhD1, Eric A. Tesdahl, PhD1, James S. Harrop, MD2, Alexander R. Vaccaro, MD, PhD3, Bradley A. Wallace, MD4, William B. Wilent, PhD, DABNM1, Eugene M. Martin, CNIM5, Jeffrey Cohen, MD, PhD6; 1SpecialtyCare, Nashville, TN, US; 2Thomas Jefferson University, Philadelphia, PA, US; 3 Rothman Institute, Philadelphia, PA, US; 4Jacksonville, FL, US; 5 Wallingford, PA, US; 6SpecaltyCare, Scottsdale, AZ, US BACKGROUND CONTEXT: Intraoperative neuromonitoring (IONM) detects adverse changes in neurophysiologic function during surgery, affording the surgical team an opportunity to possibly reverse evolving injury. Little is known about the correlation between resolution of IONM changes during different stages of extradural spine surgery and postoperative neurologic outcome. PURPOSE: Determine the relative risk of new onset postoperative neurologic deficit based on occurrence and degree of resolution of neuromonitoring changes during different stages of extradural spine surgery. STUDY DESIGN/SETTING: Retrospective review of records. PATIENT SAMPLE: Patients who have had extradural spine surgery with intraoperative neuromonitoring. OUTCOME MEASURES: Postoperative neurologic status. METHODS: We reviewed neuromonitoring records from a multiinstitutional database of 107,447 adult extradural spine surgeries performed between 2013 and 2016. We categorized each case according to alert status (no alerts during surgery, fully resolved alerts, partially resolved alerts, unresolved alerts) and surgical stage of alert (pre-incision, exposure, main procedure, closure). Surgical stage for cases with more than one IONM alert was defined by the alert with the lowest degree of resolution. We used logistic regression with the posthoc Tukey HSD test for multiple comparisons to assess the joint effect of surgical stage and alert status upon the rate of new neurologic deficit. RESULTS: Neuromonitoring alerts occurred in 12,582 of 107,447 (11.7%) cases. Alerts occurred prior to incision in 896 of 12,582 (7.1%) cases, during exposure in 902 (7.2%), following exposure in 10,431 (82.9%) and during closure in 353 (2.8%). Full resolution was noted for alerts occurring prior to incision in 423 of 896 (47.2%) cases, during exposure in 649 of 902 (72%), during the main procedure in 7,696 of 10,431 (73.8%) and during closure in 81 of 353 (22.9%). New neurologic deficits were noted following postoperative wakeup in 675 of 107,447 (0.63%) cases. Logistic regression model results indicated that cases with unresolved alerts during the main procedure were associated with the highest risk of new postoperative neurologic deficit compared to those with no alerts (OR=48.5, p<.0001), followed by cases with unresolved alerts occurring during exposure (OR=21.1, p<.0001), and those with partially resolved alerts during the main procedure (OR=17.2, p<.0001). Cases with unresolved alerts in any stage of the procedure were associated with statistically significant increases in risk of postoperative deficit compared to those with no alerts (p<.0001), as were cases with partially resolved alerts in any stage of surgery but closure (p<.034 or smaller). CONCLUSIONS: While the highest risk of neurologic injury in extradural spine surgery occurs during the main procedure, there is no absolute safe period. Continuous intraoperative neuromonitoring vigilance in all stages of surgery from pre-incision through closure can prompt timely surgical in-
Friday, October 27, 2017 3:50 PM–4:50 PM Cervical Spine 240. Observed Patterns of Cervical Radiculopathy: How Often Do They Differ from a Standard, “Netter-Diagram” Distribution? Steven J. McAnany, MD; Washington University Orthopedics, St Louis, MO, USA BACKGROUND CONTEXT: Traditionally, cervical radiculopathy is thought to present with symptoms and signs in the distribution of the compressed root that follow a standard, reproducible pattern as seen in a “Netter diagram.” However, in actual clinical practice, patients may present in a way that does not fit a textbook pattern. To date, no study has directly examined cervical radicular patterns attributable to single-level pathology in patients undergoing ACDF. PURPOSE: The purpose of this study is to examine cervical radiculopathy patterns in a surgical population and determine how often patients present with the standard vs non-standard patterns. STUDY DESIGN/SETTING: Retrospective review of a prospectively collected database of patients undergoing single-level ACDF for cervical radiculopathy. PATIENT SAMPLE: Patients with single-level cervical radiculopathy operated on between March 2011 and March 2016 by six surgeons. OUTCOME MEASURES: Not applicable. METHODS: We identified all patients with single-level cervical radiculopathy operated on between March 2011 and March 2016 by six surgeons. Criteria for inclusion included: advanced imaging demonstrating root compression at the level of surgery, no cervical spinal cord compression, and at least 75% reduction in preoperative radicular symptoms after primary single-level ACDF. The observed pattern of radiculopathy at presentation—including associated neck, shoulder, upper arm, forearm, and hand pain/numbness—was determined from chart review and patient-derived pain diagrams. This observed pattern was compared to a “standard” pattern of radiculopathy as defined by the Keegan and Garrett dermatomal map. Fisher’s exact test was used to analyze categorical data and Student’s t-test was used for continuous variables. In those patients with non-standard radicular patterns, a oneway ANOVA was used to determine differences in the observed vs expected radicular pattern. A logistic regression model was used to determine the effect of demographic variables on presentation with a non-standard radicular pattern. RESULTS: Overall, 239 cervical levels were identified (C3–4: 15; C4–5: 24; C5–6: 108; C6–7: 85; C7-T1: 7). The observed pattern of pain and numbness followed the standard pattern in only 54% (129/239; p=.35). When a non-standard radicular pattern was present, it differed by 1.68 dermatomal levels from the Keegan and Garrett standard (p<.0001). Neck pain on the radiculopathy side was the most prevalent symptom—it was found in 81% (193/239) of patients and did not differ by cervical level (p=.72). Shoulder pain, the next most prevalent symptom, was observed in 59% (142/239) of patients and also did not differ by cervical level (p=.21). Isolated neck and shoulder pain was present in 19% of the patients and was significantly more prevalent at C3–4 and C4–5 (p=.0001). However, 15% (28/193) of patients with pathology at C5–6 and C6–7 presented with isolated neck/shoulder pain and no other radicular symptoms in the arm or hand. The logistic regression model was statistically significant (χ2=16.5, p=.04), but none of the demographic variables of interest were found to significantly impact the likelihood of presenting with a non-standard radicular pattern.
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NASS 32nd Annual Meeting Proceedings / The Spine Journal 17 (2017) S111–S165
CONCLUSIONS: Observed patterns of cervical radiculopathy only followed the standard pattern in 54% of patients and did not differ by the cervical level involved. Additionally, patients with C3–4 and C4–5 radiculopathy frequently had symptoms in the distal limb, whereas patients with C5–6 and C6–7 radiculopathy frequently had symptoms only in the proximal limb. Cervical radiculopathy often presents with a non-standard pattern. Surgeons should think broadly when identifying causative levels because they frequently may not adhere to the accepted standard in actual clinical practice. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.07.294
aged 50–59, 60–69, and 70–79 regardless of whether the procedure involved an anterior or posterior approach. CONCLUSIONS: Although patients age 80+ encountered more systemic complications following cervical spine surgery, their level of functional improvement was not significantly different from patients of younger age groups. These findings suggest that it is reasonable for elderly patients with degenerative cervical spine disease who are deemed healthy enough for surgery to expect similar improvements as younger patients, thus age should not be the only factor in the decision to undergo surgery for degenerative cervical spinal stenosis. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.07.295
241. Outcomes of Degenerative Cervical Spinal Stenosis Surgeries in Elderly Populations Arya Ahmady, BS1, Christopher G. Furey, MD2, Jason D. Eubanks, MD3, Zachary L. Gordon, MD4; 1Case Western Reserve University School of Medicine, Cleveland, OH, USA; 2Case Western Reserve University, Cleveland, OH, USA; 3University Hospitals Cleveland Medical Center, Cleveland, OH, USA; 4Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA BACKGROUND CONTEXT: Although research exists on the surgical outcomes of degenerative cervical spinal stenosis, little information exists on the long-term outcomes in the elderly, specifically octogenarians. Among the studies that do exist, most of them examine only one time point rather than following patients over time postoperatively. Lastly, few studies compare the outcomes of patient groups with differing preoperative physical and neurological statuses. PURPOSE: This study aims to determine the functional outcomes of surgeries used to treat degenerative cervical disease in elderly populations over the course of several postoperative patient visits, along with how these outcomes are affected by preoperative physical and neurological statuses. In line with evidence from previous studies, we hypothesize that despite preoperative status, posterior fusion surgeries to treat degenerative cervical spinal stenosis will have the highest rates of complications and the lowest increase JOA and Nurick score in older age groups, specifically patients 80 years or older. STUDY DESIGN/SETTING: See Methods. PATIENT SAMPLE: See Methods. OUTCOME MEASURES: See Methods. METHODS: A total of 108 patients with degenerative cervical disease were included in this retrospective cohort study (University Hospitals IRB number 04-16-08). Preliminary data at the time of diagnosis was noted for each patient, such as age, gender, past medical and surgical history, preoperative physical status and preoperative neurological status. To quantify improvement, The Japanese Orthopedic Association score for cervical myelopathy and Nurrick Score were calculated for each patient preoperatively and after the first postoperative visit. With each successive visit any complications were noted and classified as non-present, systemic, or local. Systemic complications were defined as any cardiac, pulmonary, vascular, or gastrointestinal issues that occurred after the surgery. Local complications included neurological problems and problems localized to the site of surgery, such as dysphagia or device failure. For analysis, patients were divided into three age groups (50–59, 60–69, 70–79, 80+), then based on preoperative physical and neurological status. RESULTS: After controlling for preoperative status, patients 80 years or older experienced more systemic complications following cervical spine surgery, specifically in the first and second postoperative visits. The most common type of systemic complications that occurred in this group were respiratory (pneumonia, hypoxemia, respiratory failure). Local complications had a higher incidence in patients of the 50–59 and 60–69 age group. Interestingly, patients age 80 years or older had similar increases in postoperative function compared to younger age groups, quantified by the percent increases in JOA score and change in Nurick score. Lastly patients the 80+ age group had similar improvements in postoperative function as patients
242. Comparative Effectiveness of Single-Level Anterior Cervical Discectomy and Fusion vs Posterior Cervical Foraminotomy for Patients with Cervical Radiculopathy: Analysis from Quality Outcome Database Anthony L. Asher, MD1, Clinton J. Devin, MD2, Silky Chotai, MD2, Mohamad Bydon, MD3, Ahilan Sivaganesan, MD2, Matthew J. McGirt, MD1, Hui Nian4, Kristin R. Archer, PhD, DPT2, Frank E. Harrell Jr., PhD2, Kevin T. Foley, MD, FACS5, Steven D. Glassman, MD6, Christopher I. Shaffrey, MD7; 1Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA; 2Vanderbilt University Medical Center, Nashville, TN, USA; 3Mayo Clinic, Rochester, MN, USA; 4Vanderbilt University, Nashville, TN, USA; 5Semmes-Murphey Clinic, Memphis, TN, USA; 6Norton Leatherman Spine Center, Louisville, KY, USA; 7University of Virginia, Charlottesville, VA, USA BACKGROUND CONTEXT: Cervical spine surgeries are one of the most common surgical procedures performed in the United States. Cervical radiculopathy that fails to respond to nonoperative management is treated by either anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). PURPOSE: In this analysis, we set out to determine the comparative effectiveness of ACDF vs PCF for patients undergoing elective spine surgery for single-level cervical radiculopathy. STUDY DESIGN/SETTING: Analysis of prospective multicenter longitudinal registry based data. PATIENT SAMPLE: A total of 881 patients undergoing ACDF and 42 undergoing PCF for single-level cervical radiculopathy were queried from a prospective multicenter registry (QOD). OUTCOME MEASURES: Baseline and 12-months PROs: NDI, EQ-5D and NRS-neck pain (NP) and arm pain (AP) and were recorded. METHODS: Multivariable regression model was fitted for length of hospital stay (LOS), 90-day readmission, 90-day return to work (RTW) and 12month PROs and satisfaction (NASS satisfaction questionnaire). An array of preoperative variables, and surgery variables (including ACDF and PCF) were included in the model. RESULTS: In risk-adjusted multivariable analysis the patients undergoing PCF has lower LOS (OR 0.18, CI 0.071–0.42, p=.00003), had higher 12month NDI scores (OR 2.62, CI 1.5–4.7, p=.00137), and NRS-AP scores (OR 2.1, CI 1.1–3.8, p=.03) and lower quality of life (OR 0.37, CI 0.20–0.67, p=.001). The effect of surgical approach (ACDF vs PCF) was not significant for 90-day readmission, 90-day RTW and 12-month NRS-NP scores and patient satisfaction. CONCLUSIONS: Patients undergoing single-level PCF for cervical radiculopathy had lower hospital length of stay; however, these patients had worse postoperative 12-month neck-related disability, quality of life and arm pain outcomes compared to those who underwent single-level ACDF. Regarding PROs, ACDF offers a comparative benefit over PCF for singlelevel cervical radiculopathy. Further studies are needed to evaluate the longterm reoperation rates and cost-effectiveness of these procedures.
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tervention to resolve adverse changes in neurophysiologic function and help mitigate evolving neurologic injury. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.07.292
https://doi.org/10.1016/j.spinee.2017.07.291
239. Neurologic Complications May Occur During Any Stage of Extradural Spine Surgery: Intraoperative Neuromonitoring Findings and Outcomes in 107,447 Procedures Anthony K. Sestokas, PhD1, Eric A. Tesdahl, PhD1, James S. Harrop, MD2, Alexander R. Vaccaro, MD, PhD3, Bradley A. Wallace, MD4, William B. Wilent, PhD, DABNM1, Eugene M. Martin, CNIM5, Jeffrey Cohen, MD, PhD6; 1SpecialtyCare, Nashville, TN, US; 2Thomas Jefferson University, Philadelphia, PA, US; 3 Rothman Institute, Philadelphia, PA, US; 4Jacksonville, FL, US; 5 Wallingford, PA, US; 6SpecaltyCare, Scottsdale, AZ, US BACKGROUND CONTEXT: Intraoperative neuromonitoring (IONM) detects adverse changes in neurophysiologic function during surgery, affording the surgical team an opportunity to possibly reverse evolving injury. Little is known about the correlation between resolution of IONM changes during different stages of extradural spine surgery and postoperative neurologic outcome. PURPOSE: Determine the relative risk of new onset postoperative neurologic deficit based on occurrence and degree of resolution of neuromonitoring changes during different stages of extradural spine surgery. STUDY DESIGN/SETTING: Retrospective review of records. PATIENT SAMPLE: Patients who have had extradural spine surgery with intraoperative neuromonitoring. OUTCOME MEASURES: Postoperative neurologic status. METHODS: We reviewed neuromonitoring records from a multiinstitutional database of 107,447 adult extradural spine surgeries performed between 2013 and 2016. We categorized each case according to alert status (no alerts during surgery, fully resolved alerts, partially resolved alerts, unresolved alerts) and surgical stage of alert (pre-incision, exposure, main procedure, closure). Surgical stage for cases with more than one IONM alert was defined by the alert with the lowest degree of resolution. We used logistic regression with the posthoc Tukey HSD test for multiple comparisons to assess the joint effect of surgical stage and alert status upon the rate of new neurologic deficit. RESULTS: Neuromonitoring alerts occurred in 12,582 of 107,447 (11.7%) cases. Alerts occurred prior to incision in 896 of 12,582 (7.1%) cases, during exposure in 902 (7.2%), following exposure in 10,431 (82.9%) and during closure in 353 (2.8%). Full resolution was noted for alerts occurring prior to incision in 423 of 896 (47.2%) cases, during exposure in 649 of 902 (72%), during the main procedure in 7,696 of 10,431 (73.8%) and during closure in 81 of 353 (22.9%). New neurologic deficits were noted following postoperative wakeup in 675 of 107,447 (0.63%) cases. Logistic regression model results indicated that cases with unresolved alerts during the main procedure were associated with the highest risk of new postoperative neurologic deficit compared to those with no alerts (OR=48.5, p<.0001), followed by cases with unresolved alerts occurring during exposure (OR=21.1, p<.0001), and those with partially resolved alerts during the main procedure (OR=17.2, p<.0001). Cases with unresolved alerts in any stage of the procedure were associated with statistically significant increases in risk of postoperative deficit compared to those with no alerts (p<.0001), as were cases with partially resolved alerts in any stage of surgery but closure (p<.034 or smaller). CONCLUSIONS: While the highest risk of neurologic injury in extradural spine surgery occurs during the main procedure, there is no absolute safe period. Continuous intraoperative neuromonitoring vigilance in all stages of surgery from pre-incision through closure can prompt timely surgical in-
Friday, October 27, 2017 3:50 PM–4:50 PM Cervical Spine 240. Observed Patterns of Cervical Radiculopathy: How Often Do They Differ from a Standard, “Netter-Diagram” Distribution? Steven J. McAnany, MD; Washington University Orthopedics, St Louis, MO, USA BACKGROUND CONTEXT: Traditionally, cervical radiculopathy is thought to present with symptoms and signs in the distribution of the compressed root that follow a standard, reproducible pattern as seen in a “Netter diagram.” However, in actual clinical practice, patients may present in a way that does not fit a textbook pattern. To date, no study has directly examined cervical radicular patterns attributable to single-level pathology in patients undergoing ACDF. PURPOSE: The purpose of this study is to examine cervical radiculopathy patterns in a surgical population and determine how often patients present with the standard vs non-standard patterns. STUDY DESIGN/SETTING: Retrospective review of a prospectively collected database of patients undergoing single-level ACDF for cervical radiculopathy. PATIENT SAMPLE: Patients with single-level cervical radiculopathy operated on between March 2011 and March 2016 by six surgeons. OUTCOME MEASURES: Not applicable. METHODS: We identified all patients with single-level cervical radiculopathy operated on between March 2011 and March 2016 by six surgeons. Criteria for inclusion included: advanced imaging demonstrating root compression at the level of surgery, no cervical spinal cord compression, and at least 75% reduction in preoperative radicular symptoms after primary single-level ACDF. The observed pattern of radiculopathy at presentation—including associated neck, shoulder, upper arm, forearm, and hand pain/numbness—was determined from chart review and patient-derived pain diagrams. This observed pattern was compared to a “standard” pattern of radiculopathy as defined by the Keegan and Garrett dermatomal map. Fisher’s exact test was used to analyze categorical data and Student’s t-test was used for continuous variables. In those patients with non-standard radicular patterns, a oneway ANOVA was used to determine differences in the observed vs expected radicular pattern. A logistic regression model was used to determine the effect of demographic variables on presentation with a non-standard radicular pattern. RESULTS: Overall, 239 cervical levels were identified (C3–4: 15; C4–5: 24; C5–6: 108; C6–7: 85; C7-T1: 7). The observed pattern of pain and numbness followed the standard pattern in only 54% (129/239; p=.35). When a non-standard radicular pattern was present, it differed by 1.68 dermatomal levels from the Keegan and Garrett standard (p<.0001). Neck pain on the radiculopathy side was the most prevalent symptom—it was found in 81% (193/239) of patients and did not differ by cervical level (p=.72). Shoulder pain, the next most prevalent symptom, was observed in 59% (142/239) of patients and also did not differ by cervical level (p=.21). Isolated neck and shoulder pain was present in 19% of the patients and was significantly more prevalent at C3–4 and C4–5 (p=.0001). However, 15% (28/193) of patients with pathology at C5–6 and C6–7 presented with isolated neck/shoulder pain and no other radicular symptoms in the arm or hand. The logistic regression model was statistically significant (χ2=16.5, p=.04), but none of the demographic variables of interest were found to significantly impact the likelihood of presenting with a non-standard radicular pattern.
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CONCLUSIONS: Observed patterns of cervical radiculopathy only followed the standard pattern in 54% of patients and did not differ by the cervical level involved. Additionally, patients with C3–4 and C4–5 radiculopathy frequently had symptoms in the distal limb, whereas patients with C5–6 and C6–7 radiculopathy frequently had symptoms only in the proximal limb. Cervical radiculopathy often presents with a non-standard pattern. Surgeons should think broadly when identifying causative levels because they frequently may not adhere to the accepted standard in actual clinical practice. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.07.294
aged 50–59, 60–69, and 70–79 regardless of whether the procedure involved an anterior or posterior approach. CONCLUSIONS: Although patients age 80+ encountered more systemic complications following cervical spine surgery, their level of functional improvement was not significantly different from patients of younger age groups. These findings suggest that it is reasonable for elderly patients with degenerative cervical spine disease who are deemed healthy enough for surgery to expect similar improvements as younger patients, thus age should not be the only factor in the decision to undergo surgery for degenerative cervical spinal stenosis. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.07.295
241. Outcomes of Degenerative Cervical Spinal Stenosis Surgeries in Elderly Populations Arya Ahmady, BS1, Christopher G. Furey, MD2, Jason D. Eubanks, MD3, Zachary L. Gordon, MD4; 1Case Western Reserve University School of Medicine, Cleveland, OH, USA; 2Case Western Reserve University, Cleveland, OH, USA; 3University Hospitals Cleveland Medical Center, Cleveland, OH, USA; 4Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA BACKGROUND CONTEXT: Although research exists on the surgical outcomes of degenerative cervical spinal stenosis, little information exists on the long-term outcomes in the elderly, specifically octogenarians. Among the studies that do exist, most of them examine only one time point rather than following patients over time postoperatively. Lastly, few studies compare the outcomes of patient groups with differing preoperative physical and neurological statuses. PURPOSE: This study aims to determine the functional outcomes of surgeries used to treat degenerative cervical disease in elderly populations over the course of several postoperative patient visits, along with how these outcomes are affected by preoperative physical and neurological statuses. In line with evidence from previous studies, we hypothesize that despite preoperative status, posterior fusion surgeries to treat degenerative cervical spinal stenosis will have the highest rates of complications and the lowest increase JOA and Nurick score in older age groups, specifically patients 80 years or older. STUDY DESIGN/SETTING: See Methods. PATIENT SAMPLE: See Methods. OUTCOME MEASURES: See Methods. METHODS: A total of 108 patients with degenerative cervical disease were included in this retrospective cohort study (University Hospitals IRB number 04-16-08). Preliminary data at the time of diagnosis was noted for each patient, such as age, gender, past medical and surgical history, preoperative physical status and preoperative neurological status. To quantify improvement, The Japanese Orthopedic Association score for cervical myelopathy and Nurrick Score were calculated for each patient preoperatively and after the first postoperative visit. With each successive visit any complications were noted and classified as non-present, systemic, or local. Systemic complications were defined as any cardiac, pulmonary, vascular, or gastrointestinal issues that occurred after the surgery. Local complications included neurological problems and problems localized to the site of surgery, such as dysphagia or device failure. For analysis, patients were divided into three age groups (50–59, 60–69, 70–79, 80+), then based on preoperative physical and neurological status. RESULTS: After controlling for preoperative status, patients 80 years or older experienced more systemic complications following cervical spine surgery, specifically in the first and second postoperative visits. The most common type of systemic complications that occurred in this group were respiratory (pneumonia, hypoxemia, respiratory failure). Local complications had a higher incidence in patients of the 50–59 and 60–69 age group. Interestingly, patients age 80 years or older had similar increases in postoperative function compared to younger age groups, quantified by the percent increases in JOA score and change in Nurick score. Lastly patients the 80+ age group had similar improvements in postoperative function as patients
242. Comparative Effectiveness of Single-Level Anterior Cervical Discectomy and Fusion vs Posterior Cervical Foraminotomy for Patients with Cervical Radiculopathy: Analysis from Quality Outcome Database Anthony L. Asher, MD1, Clinton J. Devin, MD2, Silky Chotai, MD2, Mohamad Bydon, MD3, Ahilan Sivaganesan, MD2, Matthew J. McGirt, MD1, Hui Nian4, Kristin R. Archer, PhD, DPT2, Frank E. Harrell Jr., PhD2, Kevin T. Foley, MD, FACS5, Steven D. Glassman, MD6, Christopher I. Shaffrey, MD7; 1Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA; 2Vanderbilt University Medical Center, Nashville, TN, USA; 3Mayo Clinic, Rochester, MN, USA; 4Vanderbilt University, Nashville, TN, USA; 5Semmes-Murphey Clinic, Memphis, TN, USA; 6Norton Leatherman Spine Center, Louisville, KY, USA; 7University of Virginia, Charlottesville, VA, USA BACKGROUND CONTEXT: Cervical spine surgeries are one of the most common surgical procedures performed in the United States. Cervical radiculopathy that fails to respond to nonoperative management is treated by either anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). PURPOSE: In this analysis, we set out to determine the comparative effectiveness of ACDF vs PCF for patients undergoing elective spine surgery for single-level cervical radiculopathy. STUDY DESIGN/SETTING: Analysis of prospective multicenter longitudinal registry based data. PATIENT SAMPLE: A total of 881 patients undergoing ACDF and 42 undergoing PCF for single-level cervical radiculopathy were queried from a prospective multicenter registry (QOD). OUTCOME MEASURES: Baseline and 12-months PROs: NDI, EQ-5D and NRS-neck pain (NP) and arm pain (AP) and were recorded. METHODS: Multivariable regression model was fitted for length of hospital stay (LOS), 90-day readmission, 90-day return to work (RTW) and 12month PROs and satisfaction (NASS satisfaction questionnaire). An array of preoperative variables, and surgery variables (including ACDF and PCF) were included in the model. RESULTS: In risk-adjusted multivariable analysis the patients undergoing PCF has lower LOS (OR 0.18, CI 0.071–0.42, p=.00003), had higher 12month NDI scores (OR 2.62, CI 1.5–4.7, p=.00137), and NRS-AP scores (OR 2.1, CI 1.1–3.8, p=.03) and lower quality of life (OR 0.37, CI 0.20–0.67, p=.001). The effect of surgical approach (ACDF vs PCF) was not significant for 90-day readmission, 90-day RTW and 12-month NRS-NP scores and patient satisfaction. CONCLUSIONS: Patients undergoing single-level PCF for cervical radiculopathy had lower hospital length of stay; however, these patients had worse postoperative 12-month neck-related disability, quality of life and arm pain outcomes compared to those who underwent single-level ACDF. Regarding PROs, ACDF offers a comparative benefit over PCF for singlelevel cervical radiculopathy. Further studies are needed to evaluate the longterm reoperation rates and cost-effectiveness of these procedures.