Perioperative Complications of Surgery for Degenerative Cervical Myelopathy: A Comparison Between 3 Procedures

Abstract

Study Design: Retrospective comparative study. Objectives: To compare the perioperative complications of propensity score-matched cohorts of patients with degenerative cervical myelopathy (DCM), who were treated with anterior cervical discectomy and fusion (ACDF), posterior laminectomy with fusion, or laminoplasty. Methods: The Humana PearlDiver Patient Record Database was queried using the International Classification of Diseases (ICD-9 and ICD-10) and the Current Procedural Terminology (CPT) codes. Propensity score-matched analysis was done using multiple Chi-squared tests with Bonferroni correction of the significance level. Results: Cohorts of 11,790 patients who had ACDF, 2,257 patients who had posterior laminectomy with fusion, and 477 patients who had laminoplasty, were identified. After propensity score matching, all the 3 groups included 464 patients. The incidence of dysphagia increased significantly following ACDF compared to laminoplasty, P < 0.001, and in laminectomy with fusion compared to laminoplasty, P < 0.001. The incidence of new-onset cervicalgia was higher in ACDF compared to laminoplasty, P = 0.005, and in laminectomy with fusion compared to laminoplasty, P = 0.004. The incidence of limb paralysis increased significantly in laminectomy with fusion compared to ACDF, P = 0.002. The revision rate at 1 year increased significantly in laminectomy with fusion compared to laminoplasty, P < 0.001, and in ACDF compared to laminoplasty, P < 0.001. Conclusions: The incidence of dysphagia following laminectomy with fusion was not different compared to ACDF. Postoperative new-onset cervicalgia and revisions were least common in laminoplasty. The highest rate of postoperative limb paralysis was noticed in laminectomy with fusion.

Biomechanical Evaluation of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases After Primary Anterior Cervical Discectomy and Fusion: A Finite Element Analysis

“…The ACDF was reported to reduce intraoperative bleeding and better preserve cervical lordosis, while laminoplasty retained more ROM ( Montano et al, 2019 ). Recently, Mohamed et al reported a higher incidence of dysphagia, new-onset cervicalgia, and increased incidence of recurrence in patients with ACDF compared to those with laminoplasty ( Mesregah et al, 2021 ). In a prospective cohort study of 60 patients with lordotic cervical spine, Liang et al reported similar sagittal alignment results between ACDF and laminoplasty, while ACDF was associated with poor cervical lordosis preservation ( Liang et al, 2019 ).…”

Reoperation and Perioperative Complications after Surgical Treatment of Cervical Radiculopathy: A Comparison between Three Procedures

“…They found that disk heights postoperatively were significantly larger than preoperative disk heights. Excessive distraction or overstuffing of the disk space during ACDF may lead to increased strain on the posterior ligaments and facet joints, thereby leading to posterior neck pain 38,42. Mesregah et al 43 found similar results in their study—they found significantly lower rates of new-onset cervicalgia after laminoplasty compared with ACDF and laminectomy with fusion.…”

Comparative Utilization of Laminoplasty in the United States and Japan

“…Laminoplasty originated in the 1970s as an alternative to laminectomy 1 . Since its adoption, literature has been published establishing that laminoplasties offer equally robust clinical outcomes as other surgical techniques, including laminectomy and fusion and anterior cervical discectomy and fusion (ACDF), in treating cervical myelopathy (CM) [2][3][4][5][6][7][8] . Laminoplasty also offers several unique advantages.…”

“…Veeravagu et al analyzed 35,962 patients with CM from 2006 to 2010 and reported that 865(2.4%) underwent laminoplasty, a finding similar to that of our study21 . Mesregah et al analyzed 15,524 patients with degenerative CM, of whom 3.3% had laminoplasty8 . Three prior studies analyzed over 50,000 patients with CM from the Nationwide Inpatient Sample (NIS) from 2001 to 2010 and concluded that ACDFs comprised 63.3% of cases12,22,23 .…”