title: Anterior Versus Posterior Approach for Multilevel Degenerative Cervical Disease: A Retrospective Propensity Score-Matched Study of the MarketScan Database.
abstract: METHODS
  Retrospective 2:1 propensity score-matched analysis on a national longitudinal database between 2006 and 2010.
  
  
  OBJECTIVE
  To compare rates of adverse events, revisions procedure rates, and payment differences in anterior cervical fusion procedures compared with posterior laminectomy and fusion procedures with at least 3 levels of instrumentation.
  
  
  BACKGROUND
  The comparative benefits of anterior versus posterior approach to multilevel degenerative cervical disease remain controversial. Recent systematic reviews have reached conflicting conclusions. We demonstrate the comparative economic and clinical outcomes of anterior and posterior approaches for multilevel cervical degenerative disk disease.
  
  
  METHODS
  We identified 13,662 patients in a national billing claims database who underwent anterior or posterior cervical fusion procedures with 3 or more levels of instrumentation. Cohorts were balanced using 2:1 propensity score matching and outcomes were compared using bivariate analysis.
  
  
  RESULTS
  With the exception of dysphagia (6.4% in anterior and 1.4% in posterior), overall 30-day complication rates were lower in the anterior approach group. The rate of any complication excluding dysphagia with anterior approaches was 12.3%, significantly lower (P < 0.0001) than that of posterior approaches, 17.8%. Anterior approaches resulted in lower hospital ($18,346 vs. $23,638) and total payments ($28,963 vs. $33,526). Patients receiving an anterior surgical approach demonstrated significantly lower rate of 30-day readmission (5.1% vs. 9.9%, P < 0.0001), were less likely to require revision surgery (12.8% vs. 18.1%, P < 0.0001), and had a shorter length of stay by 1.5 nights (P < 0.0001).
  
  
  CONCLUSIONS
  Anterior approaches in the surgical management of multilevel degenerative cervical disease provide clinical advantages over posterior approaches, including lower overall complication rates, revision procedure rates, and decreased length of stay. Anterior approach procedures are also associated with decreased overall payments. These findings must be interpreted in light of limitations inherent to retrospective longitudinal studies including absence of subjective and radiographical outcomes.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Cole
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
authors.forename: Michael
authors.initials: M
authors.lastname: Zhang
authors.forename: Tej D
authors.initials: TD
authors.lastname: Azad
authors.forename: Atman
authors.initials: A
authors.lastname: Desai
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000503:physiopathology / Q000601:surgery*; D015897:Comorbidity; D016208:Databases, Factual; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000503:physiopathology / Q000601:surgery*; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007796:Laminectomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D057216:Propensity Score; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States