title: Perioperative morbidity and mortality comparison in circumferential cervical fusion for osteomyelitis versus cervical spondylotic myelopathy.
abstract: OBJECTIVE
  The most common indications for circumferential cervical decompression and fusion are cervical spondylotic myelopathy (CSM) and cervical osteomyelitis (COM). Currently, the informed consent process prior to circumferential cervical fusion surgery is not different for these two groups of patients, as details of their diagnosis-specific risk profiles have not been quantified. The authors compared two patient cohorts with either CSM or COM treated using circumferential fusion. They sought to quantify perioperative morbidity and postoperative mortality in these two groups to assist with a diagnosis-specific informed consent process for future patients undergoing this type of surgery.
  
  
  METHODS
  Perioperative and follow-up data from two cohorts of patients who had undergone circumferential cervical decompression and fusion were analyzed. Estimated blood loss (EBL), length of stay (LOS), perioperative complications, hospital readmission, 30-day reoperation rates, change in Nurick grade, and mortality were compared between the two groups.
  
  
  RESULTS
  Twenty-two patients were in the COM cohort, and 24 were in the CSM cohort. Complications, hospital readmission, 30-day reoperation rates, EBL, and mortality were not statistically different, although patients with COM trended higher in each of these categories. There was a significantly greater LOS (p < 0.001) in the COM group and greater improvement in Nurick grade in the CSM group (p < 0.001).
  
  
  CONCLUSIONS
  When advising patients undergoing circumferential fusion about perioperative risk factors, it is important for those with COM to know that they are likely to have a higher rate of complications and mortality than those with CSM who are undergoing similar surgery. Furthermore, COM patients have less neurological improvement than CSM patients after surgery. This information may be useful to surgeons and patients in providing appropriate informed consent during preoperative planning.
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, California.
authors.forename: Rishi
authors.initials: R
authors.lastname: Wadhwa
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.forename: Darryl
authors.initials: D
authors.lastname: Lau
authors.forename: Hai
authors.initials: H
authors.lastname: Le
authors.forename: Dean
authors.initials: D
authors.lastname: Chou
authors.forename: Sanjay S
authors.initials: SS
authors.lastname: Dhall
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010019:Osteomyelitis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D055009:Spondylosis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome
keywords: COM = cervical osteomyelitis; CSM = cervical spondylotic myelopathy; EBL = estimated blood loss; LOS = length of stay; PEEK = polyetheretherketone; cervical spondylotic myelopathy; circumferential fusion; matched cohort; osteomyelitis