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Complication and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in Medicare Beneficiaries.

Research paper by Varun V Puvanesarajah, Amit A Jain, Jourdan M JM Cancienne, Adam L AL Shimer, Anuj A Singla, Francis F Shen, Hamid H Hassanzadeh

Indexed on: 26 Apr '16Published on: 26 Apr '16Published in: Spine



Abstract

Retrospective database review.To compare complication and reoperation rates following anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCFs), and anterior cervical corpectomy and fusion (ACCF) for cervical spondylotic myelopathy (CSM) using a large national database of Medicare beneficiaries.Cervical spondylotic myelopathy (CSM) is the most common cause of myelopathy in patients over 55 years and is considered the most common cause of spinal cord dysfunction in the world. Surgical treatment includes ACDF, PCF, or ACCF procedures.The PearlDiver database (2005-2012) was utilized to determine revision rates following surgical treatment of CSM by one of the aforementioned surgical treatments. Specifically, 1-2 level ACDF, ACCF, and PCF and 3+ level PCF cohorts were included. Each cohort was stratified by the age of 65 years. Survivorship curves were graphed and compared.Of the patients younger than 65 years of age, there were 10,557 patients treated with 1-2 level ACDF procedures, 1,319 patients with 1-2 level PCF procedures, 1,203 patients with 1-2 level ACCF procedures, and 2,312 patients treated with 3+ level PCF procedures. Of the elderly patients, 24,310 patients were treated with 1-2 level ACDFs, 4,776 with 1-2 level PCF procedures, 3,109 with 1-2 level ACCFs, and 7,760 with 3+ level PCFs. Patients younger than 65 years of age were significantly more likely to have a reoperation procedure, than those 65 years or older when analyzing ACCF, ACDF, and 3+ level PCF procedures. ACCFs were significantly more likely than ACDFs to require reoperation. Patients treated with PCF were consistently more likely to have non-dysphagia related complications than those treated with ACDF. Rates of transfusion, dysphagia, and hematoma/seroma formation were significantly increased with ACCF compared to ACDF within the elderly population.The elderly are significantly less likely to have a revision surgery following surgical treatment for CSM. Patients treated with ACCF are more likely to need a revision than those treated with ACDF.3.