Complication and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in Medicare Beneficiaries.
METHODS
Retrospective database review.


OBJECTIVE
To compare complication and reoperation rates after anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCFs), and anterior cervical corpectomy and fusion (ACCF) for cervical spondylotic myelopathy (CSM) using a large national database of Medicare beneficiaries.


BACKGROUND
CSM is the most common cause of myelopathy in patients over 55 years and is considered the most common cause of spinal cord dysfunction in the world. Surgical treatment includes ACDF, PCF, or ACCF procedures.


METHODS
The PearlDiver database (2005-2012) was utilized to determine revision rates after surgical treatment of CSM by one of the aforementioned surgical treatments. Specifically, 1 to 2 level ACDF, ACCF, and PCF and 3+ level PCF cohorts were included. Each cohort was stratified by the age of 65 years. Survivorship curves were graphed and compared.


RESULTS
Of the patients younger than 65 years of age, there were 10,557 patients treated with 1 to 2 level ACDF procedures, 1319 patients with 1 to 2 level PCF procedures, 1203 patients with 1 to 2 level ACCF procedures, and 2312 patients treated with 3+ level PCF procedures. Of the elderly patients, 24,310 patients were treated with 1 to 2 level ACDFs, 4776 with 1 to 2 level PCF procedures, 3109 with 1 to 2 level ACCFs, and 7760 with 3+ level PCFs. Patients younger than 65 years of age were significantly more likely to have a reoperation procedure, than those 65 years or older when analyzing ACCF, ACDF, and 3+ level PCF procedures. ACCFs were significantly more likely than ACDFs to require reoperation. Patients treated with PCF were consistently more likely to have nondysphagia-related complications than those treated with ACDF. Rates of transfusion, dysphagia, and hematoma/seroma formation were significantly increased with ACCF compared with ACDF within the elderly population.


CONCLUSIONS
The elderly are significantly less likely to have a revision surgery after surgical treatment for CSM. Patients treated with ACCF are more likely to need a revision than those treated with ACDF.


METHODS
3.
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
Varun
V
Puvanesarajah
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
Amit
A
Jain
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Jourdan M
JM
Cancienne
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Adam L
AL
Shimer
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Anuj
A
Singla
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Francis
F
Shen
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Hamid
H
Hassanzadeh
D000367:Age Factors; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D016208:Databases, Factual; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology*; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000009:adverse effects*; D055009:Spondylosis / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States