Comparison of outcomes following anterior vs posterior fusion surgery for patients with degenerative cervical myelopathy

an analysis from quality outcomes database

Anthony L. Asher, Clinton J. Devin, Panagiotis Kerezoudis, Silky Chotai, Hui Nian, Frank E. Harrell, Ahilan Sivaganesan, Matthew J. Mcgirt, Kristin R. Archer, Kevin Foley, Praveen V. Mummaneni, Erica F. Bisson, John J. Knightly, Christopher I. Shaffrey, Mohamad Bydon

Research output: Contribution to journalArticle

Abstract

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. ©

Original languageEnglish (US)
Pages (from-to)919-926
Number of pages8
JournalClinical neurosurgery
Volume84
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Spinal Cord Diseases
Databases
Length of Stay
Return to Work
Orthopedics
Neck
Diskectomy
Neck Pain
Decompression
Reoperation
Arm
Odds Ratio
Confidence Intervals
Pain

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Comparison of outcomes following anterior vs posterior fusion surgery for patients with degenerative cervical myelopathy : an analysis from quality outcomes database. / Asher, Anthony L.; Devin, Clinton J.; Kerezoudis, Panagiotis; Chotai, Silky; Nian, Hui; Harrell, Frank E.; Sivaganesan, Ahilan; Mcgirt, Matthew J.; Archer, Kristin R.; Foley, Kevin; Mummaneni, Praveen V.; Bisson, Erica F.; Knightly, John J.; Shaffrey, Christopher I.; Bydon, Mohamad.

In: Clinical neurosurgery, Vol. 84, No. 4, 01.04.2019, p. 919-926.

Research output: Contribution to journalArticle

Asher, AL, Devin, CJ, Kerezoudis, P, Chotai, S, Nian, H, Harrell, FE, Sivaganesan, A, Mcgirt, MJ, Archer, KR, Foley, K, Mummaneni, PV, Bisson, EF, Knightly, JJ, Shaffrey, CI & Bydon, M 2019, 'Comparison of outcomes following anterior vs posterior fusion surgery for patients with degenerative cervical myelopathy: an analysis from quality outcomes database', Clinical neurosurgery, vol. 84, no. 4, pp. 919-926. https://doi.org/10.1093/neuros/nyy144
Asher, Anthony L. ; Devin, Clinton J. ; Kerezoudis, Panagiotis ; Chotai, Silky ; Nian, Hui ; Harrell, Frank E. ; Sivaganesan, Ahilan ; Mcgirt, Matthew J. ; Archer, Kristin R. ; Foley, Kevin ; Mummaneni, Praveen V. ; Bisson, Erica F. ; Knightly, John J. ; Shaffrey, Christopher I. ; Bydon, Mohamad. / Comparison of outcomes following anterior vs posterior fusion surgery for patients with degenerative cervical myelopathy : an analysis from quality outcomes database. In: Clinical neurosurgery. 2019 ; Vol. 84, No. 4. pp. 919-926.
@article{6721dc7f141046aaaffe4de37e0c7265,
title = "Comparison of outcomes following anterior vs posterior fusion surgery for patients with degenerative cervical myelopathy: an analysis from quality outcomes database",
abstract = "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. {\circledC}",
author = "Asher, {Anthony L.} and Devin, {Clinton J.} and Panagiotis Kerezoudis and Silky Chotai and Hui Nian and Harrell, {Frank E.} and Ahilan Sivaganesan and Mcgirt, {Matthew J.} and Archer, {Kristin R.} and Kevin Foley and Mummaneni, {Praveen V.} and Bisson, {Erica F.} and Knightly, {John J.} and Shaffrey, {Christopher I.} and Mohamad Bydon",
year = "2019",
month = "4",
day = "1",
doi = "10.1093/neuros/nyy144",
language = "English (US)",
volume = "84",
pages = "919--926",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Comparison of outcomes following anterior vs posterior fusion surgery for patients with degenerative cervical myelopathy

T2 - an analysis from quality outcomes database

AU - Asher, Anthony L.

AU - Devin, Clinton J.

AU - Kerezoudis, Panagiotis

AU - Chotai, Silky

AU - Nian, Hui

AU - Harrell, Frank E.

AU - Sivaganesan, Ahilan

AU - Mcgirt, Matthew J.

AU - Archer, Kristin R.

AU - Foley, Kevin

AU - Mummaneni, Praveen V.

AU - Bisson, Erica F.

AU - Knightly, John J.

AU - Shaffrey, Christopher I.

AU - Bydon, Mohamad

PY - 2019/4/1

Y1 - 2019/4/1

N2 - 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. ©

AB - 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. ©

UR - http://www.scopus.com/inward/record.url?scp=85062964541&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062964541&partnerID=8YFLogxK

U2 - 10.1093/neuros/nyy144

DO - 10.1093/neuros/nyy144

M3 - Article

VL - 84

SP - 919

EP - 926

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 4

ER -