title: Comparison of perioperative complications following staged versus one-day anterior and posterior cervical decompression and fusion crossing the cervico-thoracic junction.
abstract: BACKGROUND
  Multilevel cervical pathology may be treated via combined anterior cervical decompression and fusion (ACDF) followed by posterior spinal instrumented fusion (PSIF) crossing the cervico-thoracic junction. The purpose of the study was to compare perioperative complication rates following staged versus same day ACDF combined with PSIF crossing the cervico-thoracic junction.
  
  
  METHODS
  A retrospective review of consecutive patients undergoing ACDF followed by PSIF crossing the cervico-thoracic junction at a single institution was performed. Patients underwent either same day (group A) or staged with one week interval surgeries (group B). The minimum follow-up was 12 months.
  
  
  RESULTS
  Thirty-five patients (14 females and 21 males) were analyzed. The average age was 60 years (37-82 years). There were 12 patients in group A and 23 in group B. Twenty-eight complications noted in 14 patients (40%) included: dysphagia in 13 (37%), dysphonia in 6 (17%), post-operative reintubation in 4 (11%), vocal cords paralysis, delirium, superficial incisional infection and cerebrospinal fluid leakage each in one case. Significant differences comparing group A vs. B were found in: the number of levels fused posteriorly (5 vs. 7; p=0.002), total amount of intravenous fluids (3233ml vs. 4683ml; p=0.03), length of hospital stay (10 vs. 18 days; p=0.03) and transfusion of blood products (0 vs. 9 patients). Smoking and cervical myelopathy were the most important risk factors for perioperative complications regardless of the group.
  
  
  CONCLUSIONS
  Staging anterior cervical decompression and fusion with posterior cervical instrumented fusion 1 week apart does not decrease the incidence of perioperative complications.
authors.affiliation: Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, United States.
authors.forename: Kris
authors.initials: K
authors.lastname: Siemionow
authors.affiliation: Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, United States; Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, The Medical Centre of Postgraduate Education, Otwock, Poland. Electronic address: marcintyrak@gmail.com.
authors.forename: Marcin
authors.initials: M
authors.lastname: Tyrakowski
authors.affiliation: Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, United States.
authors.forename: Kushal
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, United States.
authors.forename: Sergey
authors.initials: S
authors.lastname: Neckrysh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cervical spine; Decompression; Instrumented fusion; Perioperative complication