- Email: [email protected]
Surgical Management of Non-Ambulatory Patients with Cervical Spondylotic Myelopathy
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S Orthopedic Assessment Scale (mJOA), the Nurick scale, the Neck Disability Index (NDI), the SF-36 Physical (PCS) and Mental (MCS) Component Scores and complications. METHODS: A total of 493 patients with CSM were enrolled in a prospective multicenter, international study in 16 sites. One year post-surgery follow-up data on 447 (93.3%) patients were analyzed for regional differences in the modified Japanese Orthopaedic Assessment scale (mJOA), Nurick Score, Neck Disability Index (NDI), Short Form 36v2, and complications using the Analysis of Covariance (ANCOVA) and adjusting for baseline differences. RESULTS: Of the patient population, 35% were female; average age 56.4 years (SD 11.91). Patients underwent anterior (57.7%), posterior (40.0%) or circumferential (2.3%) surgery. There was a significant (P ! 0.001) improvement from baseline values to 12 months in all outcome measures. There were significant differences in mJOA, Nurick, SF36v2 PCS and MCS outcomes among the regions. Improvement in mJOA was 2.25, 0.93, 1.45 and 2.47 in Asia, Europe, Latin America and North America, respectively. Nurick improved for 1.00, 0.74, 0.42, and 1.28 in Asia, Europe, Latin America and North America, respectively. SF36v2PCS improved for 6.71, 2.18, 3.83 and 4.05 in Asia, Europe, Latin America and North America, respectively. SF36v2MCS improved for 5.65, 1.59, 8.76 and 4.37 in Asia, Europe, Latin America and North America, respectively. There were 7 cases of C5 radiculopathy, 14 dural tears, 24 cases of dysphagia, 3 cases of dysphonia and 18 cases of progression of myelopathy. CONCLUSIONS: Surgery for CSM is effective at one year follow-up. This large prospective global clinical study shows that surgical treatment for CSM is associated with significant differences in outcomes in different regions. Sources of these differences warrant further investigation. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.041
25. Laminoplasty versus Laminectomy and Fusion to Treat Cervical Spondylotic Myelopathy: Outcomes of the Prospective Multicenter AOSpine International CSM Study Michael G. Fehlings, MD, PhD, FRCSC1, Branko Kopjar, MD, PhD2, Helton Luiz A. Defino, MD, PhD3, Shashank Kale, MD4, Giuseppe Barbagallo, MD, MD5, Ronald Bartels, MD, PhD6, Qiang Zhou, MD7, Paul M. Arnold, MD8, Mehmet Zileli, MD9, Gamaliel Tan, MD10, Yasutsugu Yukawa, MD11, Osmar J. Moraes, MD12, Massimo Scerrati, MD, PhD13, Masato Tanaka, MD14, Tomoaki Toyone, MD, PhD15, Ciaran Bolger, FRCS, PhD16, Manuel Alvarado, MD17; 1Toronto Western Hospital, Toronto, ON, Canada; 2University of Washington, Seattle, WA, US; 3University of S~ ao Paulo Ribeirao Preto, S~ao Paulo, Brazil; 4All India Institute of Medical Sciences, New Delhi, India; 5Medical University of Catania, Catania, Italy; 6Canisius Wilhelmina Hospital, Nijmegan, The Netherlands; 7Southwestern Hospital, ChongQing, China; 8University of Kansas Medical Center Department of Neurosurgery, Kansas City, KS, US; 9 Ege University, Izmir, Turkey; 10Tan Tock Seng Hospital, Jurong Health Services, Singapore, Singapore; 11Chubu Rosai Hospital, Nagoya, Japan; 12 Hospital Santa Marcelina, S~ao Paulo, Brazil; 13Medical University of Ancona, Ancona, Italy; 14Okayama University, Okayama, Japan; 15Teikyo Chiba Medical University, Chiba, Japan; 16Beaumont Hospital, Dublin, Ireland; 17Hospital San Juan de Dios, Caracas, Venezuela BACKGROUND CONTEXT: Recent studies conducted in North America have demonstrated benefits of surgical treatment for symptomatic cervical spondylotic myelopathy (CSM). However, differences in pathology, comorbidities, treatment approaches and cultural response to treatment may affect the generalizability of these findings at the global level.
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PURPOSE: The optimal posterior surgical approach to treat CSM remains debated with varying opinions favoring laminectomy and fusion vs laminoplasty. To address this controversy, we present an analysis of a prospective observational multicenter study examining outcomes of surgical treatment for CSM. STUDY DESIGN/SETTING: Prospective, multicenter, cohort study involving sites in Europe, Asia, South America and North America. PATIENT SAMPLE: Patients receiving surgery for clinically symptomatic CSM were enrolled in a prospective multicenter, cohort study at 16 sites in Europe, Asia, North and South America. OUTCOME MEASURES: Independent assessment of a series of generic and disease specific outcome measures including: modified Japanese Orthopedic Assessment Scale (mJOA), the Nurick scale, the Neck Disability Index (NDI) and the SF-36 Physical (PCS) and Mental (MCS) Component Scores. METHODS: Subjects included were a part of a larger ongoing prospective observational study that has enrolled 493 subjects with CSM involving 16 clinical sites in Europe, Asia, North and South America. Of those, 108 received laminectomy and fusion; 66 received laminoplasty. The choice of surgical approach was at the discretion of the surgeon. RESULTS: Average age was 60.2 years (SD 10.8), 29.8% were female. Subjects treated with laminectomy and fusion had more levels operated (5.0 vs. 4.4, P!.01), shorter length of stay (7.7 vs. 15.7 days, P ! .01) and less severe neurologic impairment measured by mJOA (12.6 vs. 11.2, P ! .01). There were no differences in age, and baseline NDI, SF36v2 PCS and SF36v2 MCS. At 12 month follow-up, there were no differences in neurologic and functional outcomes for laminoplasty compared to laminectomy and fusion; mJOA (3.0 and 2.3, respectively, P50.15). Moreover, there were no differences in NDI (13.3 and 12.0, respectively, P50.71), SF-36v2 PCS (8.5 and 7.7, respectively, P50.66) and SF-36v2 MCS (7.9 and 6.9, respectively, P50.56). CONCLUSIONS: Patients undergoing laminectomy and fusion and laminoplasty surgery for CSM show similar improvements in generic and disease specific outcome measures allowing for baseline differences in clinical presentation between the two groups of patients. Longer term follow-up will be required to determine whether any differences in outcome between the two forms of treatment emerge. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.042
26. Surgical Management of Non-Ambulatory Patients with Cervical Spondylotic Myelopathy Christopher G. Furey, MD1, Katherine Sadowski, BS2, Jung U. Yoo, MD3, Nicholas U. Ahn, MD4, Sanford E. Emery, MD, MBA5; 1Case Western Reserve University, Cleveland, OH, US; 2Cleveland, OH, US; 3Oregon Health and Science University, Portland, OR, US; 4University Hospital of Cleveland Department of Orthopedic Surgery, Cleveland, OH, US; 5West Virginia University, Morgantown, WV, US BACKGROUND CONTEXT: Cervical spondylotic myelopathy (CSM) is effectively managed with surgery, with the majority of patients experiencing neurologic improvement. However, patients with advanced myelopathy, in particular those rendered non-ambulatory, may have less potential for improvement. In patients with such severe neurologic dysfunction, it is unclear whether surgery will allow for improvement or will only prevent further neurologic deterioration. PURPOSE: To evaluate the neurologic improvement in patients with CSM and no ability to ambulate preoperatively. To identify clinical and radiographic factors associated with the ability to regain ambulation. To compare the clinical results of non-ambulatory patients with a cohort of ambulatory patients who also underwent surgery for CSM.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
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Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S
STUDY DESIGN/SETTING: Retrospective review of a consecutive series of patients treated at a single academic medical center over a 9 year period. PATIENT SAMPLE: Two hundred eighty-six patients with multilevel CSM underwent surgery over a 9 year period. Of these, 38 patients (13%) were unable to ambulate. All patients had a minimum 2-year follow-up. OUTCOME MEASURES: Nurick Grade, Visual Analogue Scale, Neck Disability Index METHODS: Of the 38 patients, 16 (42%) were true non-ambulators (Nurick 5) and 22 (58%) could only stand with at least one person assisting, but could not ambulate (Nurick 4). There were 24 men and 14 women. Mean age was 64 years (range: 45-82). Mean duration of preoperative nonambulation was 3 months (range: 2 weeks-12 months). No patient had prior cervical spine surgery. A multilevel corpectomy and fusion was performed in 20 patients (52%), laminoplasty in 10 (26%), laminectomy and fusion in 6 (16%), and anterior corpectomy fusion with posterior fusion in 2 (5%). Multivariate logistic regression analysis was employed to assess the effect of clinical and radiographic factors associated on the ability to regain ambulation and on symptomatic improvement. Additionally, clinical outcomes of the 38 preoperative non-ambulators were compared to the 248 preoperative ambulators who underwent surgery during the same time period. RESULTS: Following surgery, 28 of 38 (74%) patients regained the ability to ambulate, including 10 of 16 Nurick 5 patients (63%) and 18 of the 22 Nurick 4 patients (82%). Four of the 6 Nurick 5 patients who did not regain ambulation, did improve enough to stand and transfer. The mean improvement for all patients was 2.2 Nurick Grades. Of those who regained the ability to ambulate, improvement occurred within 6 months of surgery in each case. Significant clinical factors for regaining ambulation were: age! 70, duration of preoperative nonambulation ! 3 months, absence of diabetes or coronary disease, and residence at home (rather than institutional living). Significant radiographic features for regaining ambulation included absence of T2weighted cord signal change and compression of cord not less than 40% of normal diameter. Notable factors not significantly related to ability to regain ambulation were: gender, number of stenotic levels, type of surgical procedure, or occurrence of a postoperative complication or need for additional surgery. The mean Nurick Grade improvement in preoperative ambulators was 2.8 grades, compared with 2.2 in non-ambulators (p5.03). The mean improvement in VAS in preoperative non-ambulators was 3.4 compared with 4.2 in ambulators (p5.04). The mean postoperative hospital stays was 4.2 days in the preoperative non-ambulators and 3.1 in the preoperative ambulators (p5.03). Major complication rate and need for further surgery was not significantly different in the two cohorts. The mean postoperative Neck Disability Index in preoperative non-ambulators was 22.4 compared with 11.2 in preoperative ambulators (p5.02). CONCLUSIONS: The majority of non-ambulatory patients with CSM improved following surgery and regained the ability to ambulate. Younger, healthier patients and those with preoperative periods of non-ambulation less than 3 months were more likely to improve. Symptomatic improvement was likely to occur in non-ambulators following surgery, though to a lesser extent than patients who were ambulatory prior to surgery. Adverse events following surgery were no greater in non-ambulators, although hospital stays were longer. Surgical intervention is indicated in the most disabled of patients with CSM, as the majority will have improvement, although the ability to ambulate preoperatively allows for a more predictable degree of improvement following surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
27. Perioperative Outcomes after Cervical Laminoplasty versus Posterior Decompression and Fusion: Analysis of 779 Patients in the ACS-NSQIP Database Arya G. Varthi, MD1, Bryce Basques2, Daniel D. Bohl, MPH1, Jonathan N. Grauer, MD1; 1Yale University School of Medicine, New Haven, CT, US; 2New Haven, CT, US
http://dx.doi.org/10.1016/j.spinee.2014.08.043
http://dx.doi.org/10.1016/j.spinee.2014.08.044
BACKGROUND CONTEXT: Cervical myelopathy is a concerning pathology that is the most common indication for multilevel posterior cervical decompression procedures. In patients with multilevel cervical stenosis and less than 10 degrees of cervical kyphosis, the two most widely accepted surgical options are currently cervical laminoplasty and posterior cervical decompression and fusion. PURPOSE: The study utilizes the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to compare the demographics, adverse events, operative times, lengths of stay, and readmission rates in patients with multilevel cervical pathology treated with decompression and fusion versus laminoplasty. STUDY DESIGN/SETTING: A retrospective cohort study was conducted using the ACS-NSQIP database. Patients who underwent cervical laminoplasty and posterior cervical decompression and fusion from 2010 to 2012 were selected using Current Procedural Terminology (CPT) codes. PATIENT SAMPLE: A total of 779 patients in the ACS-NSQIP database with multi-level cervical spine pathology were identified; 342 patients with cervical laminoplasty (43.9% of the total study population) and 437 patients undergoing a posterior cervical decompression and fusion (56.1% of the total study population). OUTCOME MEASURES: The intraoperative variables that were studied included preoperative room time and operative time. Preoperative room time was defined as the minutes between the patient entering the operating room and the opening incision. Operative time was defined as the minutes from opening incision to wound closure. The postoperative variables that were studied included postoperative room time (defined as minutes from wound closure to the patient leaving the operating room), postoperative length of stay (defined as calendar days from operation to discharge), serious adverse events, minor adverse events and readmission. METHODS: Baseline patient characteristics were compared using Pearson’s chi-squared test. Multivariate regressions were performed for each outcome variable, controlling for age, sex, Charlson Comorbidity Index (CCI), body mass index (BMI), and American Society of Anesthesiologists (ASA) class. RESULTS: At baseline, decompression and fusion patients had increased ASA class (p ! 0.001) and increased CCI scores (p 5 0.001) compared to laminoplasty patients. Multivariate analysis was used to control for differences in baseline patient characteristics, and found that decompression and fusion patients had increased operative time compared to laminoplasty patients (þ24 minutes, p 5 0.006). There was no statistical difference in the rates of serious adverse events or individual adverse events between groups (p 5 0.152). However, the occurrence of any minor adverse event was more common in the decompression and fusion group (p 5 0.012). Decompression and fusion patients stayed an average of 1.2 days longer than laminoplasty patients (p ! 0.001) and were 2.4 times more likely to be readmitted than laminoplasty patients (p50.027). CONCLUSIONS: Posterior cervical decompression and fusion patients were found to have an increased comorbidity burden at baseline and had slightly worse short-term outcomes than laminoplasty patients. The difference in short-term outcomes may be related the fact that the decompression and fusion patients were sicker at baseline than laminoplasty patients or partially inherent to the procedure itself. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
25. Laminoplasty versus Laminectomy and Fusion to Treat Cervical Spondylotic Myelopathy: Outcomes of the Prospective Multicenter AOSpine International CSM Study Michael G. Fehlings, MD, PhD, FRCSC1, Branko Kopjar, MD, PhD2, Helton Luiz A. Defino, MD, PhD3, Shashank Kale, MD4, Giuseppe Barbagallo, MD, MD5, Ronald Bartels, MD, PhD6, Qiang Zhou, MD7, Paul M. Arnold, MD8, Mehmet Zileli, MD9, Gamaliel Tan, MD10, Yasutsugu Yukawa, MD11, Osmar J. Moraes, MD12, Massimo Scerrati, MD, PhD13, Masato Tanaka, MD14, Tomoaki Toyone, MD, PhD15, Ciaran Bolger, FRCS, PhD16, Manuel Alvarado, MD17; 1Toronto Western Hospital, Toronto, ON, Canada; 2University of Washington, Seattle, WA, US; 3University of S~ ao Paulo Ribeirao Preto, S~ao Paulo, Brazil; 4All India Institute of Medical Sciences, New Delhi, India; 5Medical University of Catania, Catania, Italy; 6Canisius Wilhelmina Hospital, Nijmegan, The Netherlands; 7Southwestern Hospital, ChongQing, China; 8University of Kansas Medical Center Department of Neurosurgery, Kansas City, KS, US; 9 Ege University, Izmir, Turkey; 10Tan Tock Seng Hospital, Jurong Health Services, Singapore, Singapore; 11Chubu Rosai Hospital, Nagoya, Japan; 12 Hospital Santa Marcelina, S~ao Paulo, Brazil; 13Medical University of Ancona, Ancona, Italy; 14Okayama University, Okayama, Japan; 15Teikyo Chiba Medical University, Chiba, Japan; 16Beaumont Hospital, Dublin, Ireland; 17Hospital San Juan de Dios, Caracas, Venezuela BACKGROUND CONTEXT: Recent studies conducted in North America have demonstrated benefits of surgical treatment for symptomatic cervical spondylotic myelopathy (CSM). However, differences in pathology, comorbidities, treatment approaches and cultural response to treatment may affect the generalizability of these findings at the global level.
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PURPOSE: The optimal posterior surgical approach to treat CSM remains debated with varying opinions favoring laminectomy and fusion vs laminoplasty. To address this controversy, we present an analysis of a prospective observational multicenter study examining outcomes of surgical treatment for CSM. STUDY DESIGN/SETTING: Prospective, multicenter, cohort study involving sites in Europe, Asia, South America and North America. PATIENT SAMPLE: Patients receiving surgery for clinically symptomatic CSM were enrolled in a prospective multicenter, cohort study at 16 sites in Europe, Asia, North and South America. OUTCOME MEASURES: Independent assessment of a series of generic and disease specific outcome measures including: modified Japanese Orthopedic Assessment Scale (mJOA), the Nurick scale, the Neck Disability Index (NDI) and the SF-36 Physical (PCS) and Mental (MCS) Component Scores. METHODS: Subjects included were a part of a larger ongoing prospective observational study that has enrolled 493 subjects with CSM involving 16 clinical sites in Europe, Asia, North and South America. Of those, 108 received laminectomy and fusion; 66 received laminoplasty. The choice of surgical approach was at the discretion of the surgeon. RESULTS: Average age was 60.2 years (SD 10.8), 29.8% were female. Subjects treated with laminectomy and fusion had more levels operated (5.0 vs. 4.4, P!.01), shorter length of stay (7.7 vs. 15.7 days, P ! .01) and less severe neurologic impairment measured by mJOA (12.6 vs. 11.2, P ! .01). There were no differences in age, and baseline NDI, SF36v2 PCS and SF36v2 MCS. At 12 month follow-up, there were no differences in neurologic and functional outcomes for laminoplasty compared to laminectomy and fusion; mJOA (3.0 and 2.3, respectively, P50.15). Moreover, there were no differences in NDI (13.3 and 12.0, respectively, P50.71), SF-36v2 PCS (8.5 and 7.7, respectively, P50.66) and SF-36v2 MCS (7.9 and 6.9, respectively, P50.56). CONCLUSIONS: Patients undergoing laminectomy and fusion and laminoplasty surgery for CSM show similar improvements in generic and disease specific outcome measures allowing for baseline differences in clinical presentation between the two groups of patients. Longer term follow-up will be required to determine whether any differences in outcome between the two forms of treatment emerge. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.042
26. Surgical Management of Non-Ambulatory Patients with Cervical Spondylotic Myelopathy Christopher G. Furey, MD1, Katherine Sadowski, BS2, Jung U. Yoo, MD3, Nicholas U. Ahn, MD4, Sanford E. Emery, MD, MBA5; 1Case Western Reserve University, Cleveland, OH, US; 2Cleveland, OH, US; 3Oregon Health and Science University, Portland, OR, US; 4University Hospital of Cleveland Department of Orthopedic Surgery, Cleveland, OH, US; 5West Virginia University, Morgantown, WV, US BACKGROUND CONTEXT: Cervical spondylotic myelopathy (CSM) is effectively managed with surgery, with the majority of patients experiencing neurologic improvement. However, patients with advanced myelopathy, in particular those rendered non-ambulatory, may have less potential for improvement. In patients with such severe neurologic dysfunction, it is unclear whether surgery will allow for improvement or will only prevent further neurologic deterioration. PURPOSE: To evaluate the neurologic improvement in patients with CSM and no ability to ambulate preoperatively. To identify clinical and radiographic factors associated with the ability to regain ambulation. To compare the clinical results of non-ambulatory patients with a cohort of ambulatory patients who also underwent surgery for CSM.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
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Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S
STUDY DESIGN/SETTING: Retrospective review of a consecutive series of patients treated at a single academic medical center over a 9 year period. PATIENT SAMPLE: Two hundred eighty-six patients with multilevel CSM underwent surgery over a 9 year period. Of these, 38 patients (13%) were unable to ambulate. All patients had a minimum 2-year follow-up. OUTCOME MEASURES: Nurick Grade, Visual Analogue Scale, Neck Disability Index METHODS: Of the 38 patients, 16 (42%) were true non-ambulators (Nurick 5) and 22 (58%) could only stand with at least one person assisting, but could not ambulate (Nurick 4). There were 24 men and 14 women. Mean age was 64 years (range: 45-82). Mean duration of preoperative nonambulation was 3 months (range: 2 weeks-12 months). No patient had prior cervical spine surgery. A multilevel corpectomy and fusion was performed in 20 patients (52%), laminoplasty in 10 (26%), laminectomy and fusion in 6 (16%), and anterior corpectomy fusion with posterior fusion in 2 (5%). Multivariate logistic regression analysis was employed to assess the effect of clinical and radiographic factors associated on the ability to regain ambulation and on symptomatic improvement. Additionally, clinical outcomes of the 38 preoperative non-ambulators were compared to the 248 preoperative ambulators who underwent surgery during the same time period. RESULTS: Following surgery, 28 of 38 (74%) patients regained the ability to ambulate, including 10 of 16 Nurick 5 patients (63%) and 18 of the 22 Nurick 4 patients (82%). Four of the 6 Nurick 5 patients who did not regain ambulation, did improve enough to stand and transfer. The mean improvement for all patients was 2.2 Nurick Grades. Of those who regained the ability to ambulate, improvement occurred within 6 months of surgery in each case. Significant clinical factors for regaining ambulation were: age! 70, duration of preoperative nonambulation ! 3 months, absence of diabetes or coronary disease, and residence at home (rather than institutional living). Significant radiographic features for regaining ambulation included absence of T2weighted cord signal change and compression of cord not less than 40% of normal diameter. Notable factors not significantly related to ability to regain ambulation were: gender, number of stenotic levels, type of surgical procedure, or occurrence of a postoperative complication or need for additional surgery. The mean Nurick Grade improvement in preoperative ambulators was 2.8 grades, compared with 2.2 in non-ambulators (p5.03). The mean improvement in VAS in preoperative non-ambulators was 3.4 compared with 4.2 in ambulators (p5.04). The mean postoperative hospital stays was 4.2 days in the preoperative non-ambulators and 3.1 in the preoperative ambulators (p5.03). Major complication rate and need for further surgery was not significantly different in the two cohorts. The mean postoperative Neck Disability Index in preoperative non-ambulators was 22.4 compared with 11.2 in preoperative ambulators (p5.02). CONCLUSIONS: The majority of non-ambulatory patients with CSM improved following surgery and regained the ability to ambulate. Younger, healthier patients and those with preoperative periods of non-ambulation less than 3 months were more likely to improve. Symptomatic improvement was likely to occur in non-ambulators following surgery, though to a lesser extent than patients who were ambulatory prior to surgery. Adverse events following surgery were no greater in non-ambulators, although hospital stays were longer. Surgical intervention is indicated in the most disabled of patients with CSM, as the majority will have improvement, although the ability to ambulate preoperatively allows for a more predictable degree of improvement following surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
27. Perioperative Outcomes after Cervical Laminoplasty versus Posterior Decompression and Fusion: Analysis of 779 Patients in the ACS-NSQIP Database Arya G. Varthi, MD1, Bryce Basques2, Daniel D. Bohl, MPH1, Jonathan N. Grauer, MD1; 1Yale University School of Medicine, New Haven, CT, US; 2New Haven, CT, US
http://dx.doi.org/10.1016/j.spinee.2014.08.043
http://dx.doi.org/10.1016/j.spinee.2014.08.044
BACKGROUND CONTEXT: Cervical myelopathy is a concerning pathology that is the most common indication for multilevel posterior cervical decompression procedures. In patients with multilevel cervical stenosis and less than 10 degrees of cervical kyphosis, the two most widely accepted surgical options are currently cervical laminoplasty and posterior cervical decompression and fusion. PURPOSE: The study utilizes the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to compare the demographics, adverse events, operative times, lengths of stay, and readmission rates in patients with multilevel cervical pathology treated with decompression and fusion versus laminoplasty. STUDY DESIGN/SETTING: A retrospective cohort study was conducted using the ACS-NSQIP database. Patients who underwent cervical laminoplasty and posterior cervical decompression and fusion from 2010 to 2012 were selected using Current Procedural Terminology (CPT) codes. PATIENT SAMPLE: A total of 779 patients in the ACS-NSQIP database with multi-level cervical spine pathology were identified; 342 patients with cervical laminoplasty (43.9% of the total study population) and 437 patients undergoing a posterior cervical decompression and fusion (56.1% of the total study population). OUTCOME MEASURES: The intraoperative variables that were studied included preoperative room time and operative time. Preoperative room time was defined as the minutes between the patient entering the operating room and the opening incision. Operative time was defined as the minutes from opening incision to wound closure. The postoperative variables that were studied included postoperative room time (defined as minutes from wound closure to the patient leaving the operating room), postoperative length of stay (defined as calendar days from operation to discharge), serious adverse events, minor adverse events and readmission. METHODS: Baseline patient characteristics were compared using Pearson’s chi-squared test. Multivariate regressions were performed for each outcome variable, controlling for age, sex, Charlson Comorbidity Index (CCI), body mass index (BMI), and American Society of Anesthesiologists (ASA) class. RESULTS: At baseline, decompression and fusion patients had increased ASA class (p ! 0.001) and increased CCI scores (p 5 0.001) compared to laminoplasty patients. Multivariate analysis was used to control for differences in baseline patient characteristics, and found that decompression and fusion patients had increased operative time compared to laminoplasty patients (þ24 minutes, p 5 0.006). There was no statistical difference in the rates of serious adverse events or individual adverse events between groups (p 5 0.152). However, the occurrence of any minor adverse event was more common in the decompression and fusion group (p 5 0.012). Decompression and fusion patients stayed an average of 1.2 days longer than laminoplasty patients (p ! 0.001) and were 2.4 times more likely to be readmitted than laminoplasty patients (p50.027). CONCLUSIONS: Posterior cervical decompression and fusion patients were found to have an increased comorbidity burden at baseline and had slightly worse short-term outcomes than laminoplasty patients. The difference in short-term outcomes may be related the fact that the decompression and fusion patients were sicker at baseline than laminoplasty patients or partially inherent to the procedure itself. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.