Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study

Abstract

Object Rates of complications associated with the surgical treatment of cervical spondylotic myelopathy (CSM) are not clear. Appreciating these risks is important for patient counseling and quality improvement. The authors sought to assess the rates of and risk factors associated with perioperative and delayed complications associated with the surgical treatment of CSM. Methods Data from the AOSpine North America Cervical Spondylotic Myelopathy Study, a prospective, multicenter study, were analyzed. Outcomes data, including adverse events, were collected in a standardized manner and externally monitored. Rates of perioperative complications (within 30 days of surgery) and delayed complications (31 days to 2 years following surgery) were tabulated and stratified based on clinical factors. Results The study enrolled 302 patients (mean age 57 years, range 29–86) years. Of 332 reported adverse events, 73 were classified as perioperative complications (25 major and 48 minor) in 47 patients (overall perioperative complication rate of 15.6%). The most common perioperative complications included minor cardiopulmonary events (3.0%), dysphagia (3.0%), and superficial wound infection (2.3%). Perioperative worsening of myelopathy was reported in 4 patients (1.3%). Based on 275 patients who completed 2 years of follow-up, there were 14 delayed complications (8 minor, 6 major) in 12 patients, for an overall delayed complication rate of 4.4%. Of patients treated with anterior-only (n = 176), posterior-only (n = 107), and combined anterior-posterior (n = 19) procedures, 11%, 19%, and 37%, respectively, had 1 or more perioperative complications. Compared with anterior-only approaches, posterior-only approaches had a higher rate of wound infection (0.6% vs 4.7%, p = 0.030). Dysphagia was more common with combined anterior-posterior procedures (21.1%) compared with anterior-only procedures (2.3%) or posterior-only procedures (0.9%) (p < 0.001). The incidence of C-5 radiculopathy was not associated with the surgical approach (p = 0.8). The occurrence of perioperative complications was associated with increased age (p = 0.006), combined anterior-posterior procedures (p = 0.016), increased operative time (p = 0.009), and increased operative blood loss (p = 0.005), but it was not associated with comorbidity score, body mass index, modified Japanese Orthopaedic Association score, smoking status, anterior-only versus posterior-only approach, or specific procedures. Multivariate analysis of factors associated with minor or major complications identified age (OR 1.029, 95% CI 1.002–1.057, p = 0.035) and operative time (OR 1.005, 95% CI 1.002–1.008, p = 0.001). Multivariate analysis of factors associated with major complications identified age (OR 1.054, 95% CI 1.015–1.094, p = 0.006) and combined anterior-posterior procedures (OR 5.297, 95% CI 1.626–17.256, p = 0.006). Conclusions For the surgical treatment of CSM, the vast majority of complications were treatable and without long-term impact. Multivariate factors associated with an increased risk of complications include greater age, increased operative time, and use of combined anterior-posterior procedures.

Risk factors of cervical surgery related complications in patients older than 80 years

“…Koji Tamai 1) , Hidetomi Terai 1) , Akinobu Suzuki 1) , Hiroaki Nakamura 1) , Masaomi Yamashita 2) , Yawara Eguchi 3) , Shiro Imagama 4) , Kei Ando 4) , Kazuyoshi Kobayashi 4) , Morio Matsumoto 5) , Ken Ishii 5) , Tomohiro Hikata 5) , Shoji Seki 6) , Masaaki Aramomi 7) , Tetsuhiro Ishikawa 7) , Atsushi Kimura 8) , Hirokazu Inoue 8) , Gen Inoue 9) , Masayuki Miyagi 9) , Wataru Saito 9) , Kei Yamada 10) , Michio Hongo 11) , Kenji Endo 12) , Hidekazu Suzuki 12) , Atsushi Nakano 13) , Kazuyuki Watanabe 14) , Junichi Ohya 15) , Hirotaka Chikuda 15) , Yasuchika Aoki 16) , Masayuki Shimizu 17) , Toshimasa Futatsugi 17) , Keijiro Mukaiyama 17) , Masaichi Hasegawa 18) , Katsuhito Kiyasu 19) , Haku Iizuka 20) , Kotaro Nishida 21) , Kenichiro Kakutani 21) , Hideaki Nakajima 22) , Hideki Murakami 23) , Satoru Demura 23) , Satoshi Kato 23) , Katsuhito Yoshioka 23) , Takashi Namikawa 24) , Kei Watanabe 25) …”

“…Complications were further classified as minor or major. The major complications were defined as if they required invasive intervention, resulted in permanent or prolonged morbidity, or resulted in substantial prolongation of hospital stay 9,13) . Based on this definition, epidural hemorrhage, cerebral infarction, systemic edema, arrhythmia, acute respiratory disorders, and epileptic seizures were classified as major complications; delirium, C5 nerve root palsy, urinary tract infection, temporal neurological deterioration, and dural tear were classified as minor complications.…”

“…It is widely accepted that once complications occur, the health-related quality of life (HRQOL) will remarkably decrease and large additional costs will be needed 10,11) . Other factors were reported to relate to complications, such as diabetes mellitus (DM) 12) , operative time 9) , surgical procedure 9) , and the number of comorbidities 8) . However, the subjects studied in these reports were of various ages, and the risk factors specific to the elderly patients are still unknown.…”

“…What concerns surgeons when performing cervical surgery on an elderly patient is the increased incidence of complications, because "age" itself is considered a strong risk factor for complications [7][8][9] . It is widely accepted that once complications occur, the health-related quality of life (HRQOL) will remarkably decrease and large additional costs will be needed 10,11) .…”

A new parallel closing mechanism for the laminectomy rongeur makes it significantly more precise: a biomechanical and mechanical comparison study

“…In the thoracic spine, the incidence rate of cerebrospinal fluid leakage may be as high as 22% [4]. Incidental dural tears in the cervical spine are not as common as in the lumbar or thoracic spine and the incidence has been reported to range between 0.13 and 4% [5][6][7]. Dural tears may lead to severe complications, including meningitis, arachnoiditis or fistula formation.…”