Comparison of Perioperative Complications in Anterior Decompression With Fusion and Posterior Decompression With Fusion for Cervical Ossification of the Posterior Longitudinal Ligament

Abstract

Study Design. A retrospective comparative study. Objective. To compare the perioperative complications and costs of anterior decompression with fusion (ADF) and posterior decompression with fusion (PDF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data. Surgical treatment of cervical OPLL has a high risk of various complications. ADF and PDF are effective for the treatment of cervical OPLL; however, few studies have compared the two procedures in terms of the perioperative surgical complications. Methods. Patients undergoing ADF and PDF for cervical OPLL from 2010 to 2016 were identified in a nation-wide inpatient database. We investigated systemic and local complications, length of hospital stay, costs for hospitalization, reoperation, and mortality. Propensity score was calculated from patients’ characteristics and preoperative comorbidities, and one to one matching was performed. Results. Propensity score-matching produced 854 pairs of patients who underwent ADF and PDF. The rate of at least one systemic complication was significantly higher in the ADF group (P = 0.004). The incidence rates of postoperative respiratory failure (P = 0.034) and dysphagia (P = 0.008) were significantly higher in the ADF group. The rates of pneumonia (P = 0.06) and hoarseness (P = 0.08) also tended to be higher in the ADF group. However, no difference was found in the mortality rate (P = 0.22). In the local complications, spinal fluid leakage was significantly higher in the ADF group (P < 0.001). However, blood transfusion rate was significantly higher in the PDF group (P = 0.001). Hospital stay was significantly longer in the PDF group (P < 0.001) and the cost for hospitalization was greater in the PDF group (P < 0.001). Conclusion. The present study demonstrated that perioperative complications, such as respiratory failure, dysphagia, and spinal fluid leakage, were more common in the ADF group. However, hospital stay was longer in the PDF group, and the cost for hospitalization was greater in the PDF group. Level of Evidence: 3.

Risk Factors and Assessment Using an Endoscopic Scoring System for Postoperative Respiratory Complications after Anterior Cervical Decompression and Fusion Surgery

“…Additionally, postoperative respiratory complications (PRC) can cause serious problems and major issues after ADF. Past reports indicate that postoperative adverse events of a respiratory nature, such as pneumonia and airway obstruction, occur in 0.6%-14% of patients after ADF [6][7][8]9) . Sometimes, accidental airway obstruction becomes a potentially life-threatening event that may require reintubation, for which one must be prepared with an effective management plan.…”

Association between Severity of Diffuse Idiopathic Skeletal Hyperostosis and Ossification of Other Spinal Ligaments in Patients with Ossification of the Posterior Longitudinal Ligament

“…In contrast, Yoshii et al analyzed data from 2353 cases with cervical OPLL, of which 1333 cases underwent ADF and 1020 cases underwent PDF. Their report revealed that at least one local complication, such as cerebrospinal fluid leakage or surgical site infection, occurred in about 6.5% and 4.7% of anterior and posterior cases, respectively [24]. In cases with symptomatic cervical OPLL and/or DISH, including those with complications, the surgical outcomes were sometimes unsatisfactory; therefore, it is necessary to carefully monitor for neurological deterioration caused by the combination of multiple OSLs.…”

MRI T2WI High Signal Is a Risk Factor for Perioperative Complications in Patients with Cervical Spondylosis with Spinal Cord Compression: A Propensity Matching Score Analysis

“…In addition, it is of great significance to develop individualized countermeasures by comparing the perioperative complications of CSWSCC patients with or without MRI T2WIHS. In order to effectively eliminate the error caused by selection deviation, we used the propensity matching score analysis method in this study [ 12 , 13 ].…”