Differences in Patient-Reported Outcomes Between Anterior and Posterior Approaches for Treatment of Cervical Spondylotic Myelopathy: A Quality Outcomes Database Analysis

Wilkerson, Christopher; Sherrod, Brandon A.; Alvi, Mohammed Ali; Asher, Anthony L.; Coric, Domagoj; Virk, Michael S.; Fu, Kai-Ming; Foley, Kevin T.; Park, Paul; Upadhyaya, Cheerag; Knightly, John J; Shaffrey, Mark E.; Potts, Eric A; Shaffrey, Christopher I.; Wang, Michael Y.; Mummaneni, Praveen V.; Chan, Andrew K.; Bydon, Mohamad; Tumialán, Luis M.; Bisson, Erica F.

doi:10.1016/j.wneu.2022.01.049

Cited by 8 publications

(15 citation statements)

References 19 publications

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“…Other studies have suggested that the anterior approach is the preferred approach in most cases of CSM [ 33 , 34 , 35 , 36 ]. In a retrospective cohort study of 89 patients who underwent anterior or posterior decompression surgery for CSM at a single institution, Hitchon et al recommended the anterior approach due to the benefits in hospital LOS and restoration of physiological cervical lordosis compared to the posterior approach, despite similar outcomes in complications, quality of life, and sagittal balance [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective cohort study of 89 patients who underwent anterior or posterior decompression surgery for CSM at a single institution, Hitchon et al recommended the anterior approach due to the benefits in hospital LOS and restoration of physiological cervical lordosis compared to the posterior approach, despite similar outcomes in complications, quality of life, and sagittal balance [ 33 ]. Similarly, in a multi-institutional database study of 1151 patients who underwent decompression surgery for CSM, Wilkerson et al observed that after controlling for baseline differences between patients who underwent anterior or posterior surgery, the anterior approach was associated with greater improvements in NDI score at both the 3 month and 12 month follow-ups [ 34 ]. A similar conclusion was made in a meta-analysis of 25 studies including 1843 patients who underwent decompression for CSM [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

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Impact of Preoperative Frailty on Outcomes in Patients with Cervical Spondylotic Myelopathy Undergoing Anterior vs. Posterior Cervical Surgery

Elsamadicy,

Sayeed,

Sherman

et al. 2023

JCM

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Introduction: Frailty has been shown to negatively influence patient outcomes across many disease processes, including in the cervical spondylotic myelopathy (CSM) population. The aim of this study was to assess the impact that frailty has on patients with CSM who undergo anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF). Materials and Methods: A retrospective cohort study was performed using the 2016–2019 national inpatient sample. Adult patients (≥18 years old) undergoing ACDF only or PCDF only for CSM were identified using ICD codes. The patients were categorized based on receipt of ACDF or PCDF and pre-operative frailty status using the 11-item modified frailty index (mFI-11): pre-Frail (mFI = 1), frail (mFI = 2), or severely frail (mFI ≥ 3). Patient demographics, comorbidities, operative characteristics, perioperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay (LOS) and non-routine discharge (NRD). Results: A total of 37,990 patients were identified, of which 16,665 (43.9%) were in the pre-frail cohort, 12,985 (34.2%) were in the frail cohort, and 8340 (22.0%) were in the severely frail cohort. The prevalence of many comorbidities varied significantly between frailty cohorts. Across all three frailty cohorts, the incidence of AEs was greater in patients who underwent PCDF, with dysphagia being significantly more common in patients who underwent ACDF. Additionally, the rate of adverse events significantly increased between ACDF and PCDF with respect to increasing frailty (p < 0.001). Regarding healthcare resource utilization, LOS and rate of NRD were significantly greater in patients who underwent PCDF in all three frailty cohorts, with these metrics increasing with frailty in both ACDF and PCDF cohorts (LOS: p < 0.001); NRD: p < 0.001). On a multivariate analysis of patients who underwent ACDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.39, p < 0.001; (severely frail) OR: 2.25, p < 0.001] and NRD [(frail) OR: 1.49, p < 0.001; (severely frail) OR: 2.22, p < 0.001]. Similarly, in patients who underwent PCDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.58, p < 0.001; (severely frail) OR: 2.45, p < 0.001] and NRD [(frail) OR: 1.55, p < 0.001; (severely frail) OR: 1.63, p < 0.001]. Conclusions: Our study suggests that preoperative frailty may impact outcomes after surgical treatment for CSM, with more frail patients having greater health care utilization and a higher rate of adverse events. The patients undergoing PCDF ensued increased health care utilization, compared to ACDF, whereas severely frail patients undergoing PCDF tended to have the longest length of stay and highest rate of non-routine discharge. Additional prospective studies are necessary to directly compare ACDF and PCDF in frail patients with CSM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Preoperative Frailty on Outcomes in Patients with Cervical Spondylotic Myelopathy Undergoing Anterior vs. Posterior Cervical Surgery

Elsamadicy,

Sayeed,

Sherman

et al. 2023

JCM

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“…This study was a retrospective analysis of the prospectively collected Quality Outcomes Database (QOD) Cervical Spondylotic Myelopathy data set. Patients undergoing elective surgery for CSM were enrolled between January 2016 and December 2018 from 14 high-enrolling sites in the QOD 15–34 . Previous studies have documented the QOD data collection and patient enrollment criteria in detail.…”

Section: Methodsmentioning

confidence: 99%

“…Patients undergoing elective surgery for CSM were enrolled between January 2016 and December 2018 from 14 high-enrolling sites in the QOD. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Previous studies have documented the QOD data collection and patient enrollment criteria in detail. Institutional review board approval (Columbia University IRB #AAAU5620) was received for this study, and the data set did not include identifiable patient information.…”

Section: Patient Cohortmentioning

confidence: 99%

Is Upper Extremity or Lower Extremity Function More Important for Patient Satisfaction? An Analysis of 24-Month Outcomes from the QOD Cervical Spondylotic Myelopathy Cohort

Yang,

Mummaneni,

Chou

et al. 2024

Clinical Spine Surgery

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Study Design: Retrospective analysis of a prospective, multicenter registry. Objective: To assess whether upper or lower limb mJOA improvement more strongly associates with patient satisfaction after surgery for cervical spondylotic myelopathy (CSM). Summary of Background Data: The modified Japanese Orthopaedic Association (mJOA) is commonly used to assess functional status in patients with CSM. Patients present with upper and/or lower extremity dysfunction, and it is unclear whether improvement in one and/or both symptoms drives postoperative patient satisfaction. Methods: This study utilizes the prospective Quality Outcomes Database (QOD) CSM data set. Clinical outcomes included mJOA and North American Spine Society (NASS) satisfaction. The upper limb mJOA score was defined as upper motor plus sensory mJOA, and the lower limb mJOA as lower motor plus sensory mJOA. Ordered logistic regression was used to determine whether upper or lower limb mJOA was more closely associated with NASS satisfaction, adjusting for other covariates. Results: Overall, 1141 patients were enrolled in the QOD CSM cohort. In all, 780 had both preoperative and 24-month mJOA scores, met inclusion criteria, and were included for analysis. The baseline mJOA was 12.1±2.7, and postoperatively, 85.6% would undergo surgery again (NASS 1 or 2, satisfied). Patients exhibited mean improvement in both upper (baseline:3.9±1.4 vs. 24 mo:5.0±1.1, P<0.001) and lower limb mJOA (baseline:3.9±1.4 vs. 24 mon:4.5±1.5, P<0.001); however, the 24-month change in the upper limb mJOA was greater (upper:1.1±1.6 vs. lower:0.6±1.6, P<0.001). Across 24-month NASS satisfaction, the baseline upper and lower limb mJOA scores were similar (pupper=0.28, plower=0.092). However, as satisfaction decreased, the 24-month change in upper and lower limb mJOA decreased as well (pupper<0.001, plower<0.001). Patients with NASS scores of 4 (lowest satisfaction) did not demonstrate significant differences from baseline in upper or lower limb mJOA (P>0.05). In ordered logistic regression, NASS satisfaction was independently associated with upper limb mJOA improvement (OR=0.81; 95% CI: 0.68-0.97; P=0.019) but not lower limb mJOA improvement (OR=0.84; 95% CI: 0.70-1.0; P=0.054). Conclusions: As the magnitude of upper and lower mJOA improvement decreased postoperatively, so too did patient satisfaction with surgical intervention. Upper limb mJOA improvement was a significant independent predictor of patient satisfaction, whereas lower limb mJOA improvement was not. These findings may aid preoperative counseling, stratified by patients’ upper and lower extremity treatment expectations. Level of Evidence: Level—III.

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“…The main treatment for CSM is posterior cervical surgery due to its advantage of less damage to postoperative cervical mobility 6 . It is mainly divided into laminectomy and laminoplasty 7,8,9 . However, this approach involves deep midline incision and bone resection 10 , which causes serious postoperative pain to persist for at least one month 11 , resulting in increased postoperative complications, prolonged length of stay (LOS), and reduced postoperative quality of life 12,13 .…”

Section: Introductionmentioning

confidence: 99%

The use of bilateral inter-semispinal plane block to effectively enhance the recovery pathway for posterior cervical surgery—A prospective randomized controlled study

Li,

Zhang,

Sun

et al. 2023

Preprint

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Background: Bilateral inter-semispinal plane (ISP) block can be used to alleviate postoperative pain in patients underwent posterior cervical surgery, this study aimed to determine if bilateral ISP block can promote recovery after surgery for patients undergoing posterior cervical surgery. Methods: 100 patients were assigned randomly to either the control or ISP block group. The main outcome was the length of stay (LOS). The secondary outcomes include the Numerical Rating Scale(NRS) scores, times of PCIA press, and total consumption of rescue analgesic drugs. The patient’s postoperative life quality was evaluated using a 40-item quality of recovery score (QoR-40), time to first walk independently and oral intake. We also recorded postoperative negative outcomes. Result: The mean LOS in the ISP group was significantly shorter than that in the control group (7.52 ±1.34 vs. 8.98 ±1.32 days, P = 0.014). Within 24 h postoperatively, pain scores in the ISP block group were lower than in the control group (P ＜ 0.001), however, the NRS scores at 48 h were not significantly different (P = 0.631). The PCIA press times and pentazocine consumption in the ISP group were significantly reduced compared with those in the control group (P ＜ 0.001). Postoperative total QoR-40 scores and its 4 dimensions were higher in the ISP group than in the control group (P < 0.001), except the independence. Oral intake and unassisted walking in the ISP group were shorter than those in the control group (P ＜ 0.001). Adverse effects were not different in neither group (P > 0.05). Conclusion: Bilateral ISP block could significantly and safely promote recovery for patients undergoing posterior cervical surgery. Trial registration: The trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn) (No: ChiCTR2300069813); 27/03/2023

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Differences in Patient-Reported Outcomes Between Anterior and Posterior Approaches for Treatment of Cervical Spondylotic Myelopathy: A Quality Outcomes Database Analysis

Cited by 8 publications

References 19 publications

Impact of Preoperative Frailty on Outcomes in Patients with Cervical Spondylotic Myelopathy Undergoing Anterior vs. Posterior Cervical Surgery

Impact of Preoperative Frailty on Outcomes in Patients with Cervical Spondylotic Myelopathy Undergoing Anterior vs. Posterior Cervical Surgery

Is Upper Extremity or Lower Extremity Function More Important for Patient Satisfaction? An Analysis of 24-Month Outcomes from the QOD Cervical Spondylotic Myelopathy Cohort

The use of bilateral inter-semispinal plane block to effectively enhance the recovery pathway for posterior cervical surgery—A prospective randomized controlled study

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