A Comparison of Various Surgical Treatments for Degenerative Cervical Myelopathy: A Propensity Score Matched Analysis

• Published in: Global spine journal Vol. 12; no. 6; pp. 1109 - 1118
• Main Authors: Lee, Nathan J., Kim, Jun S., Park, Paul, Riew, K. Daniel
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-07-2022; Sage Publications Ltd
• Subjects: Back surgery; Original; Surgical outcomes; Surgical techniques; posterior cervical fusion; cervical laminoplasty; degenerative cervical myelopathy; anterior cervical discectomy and fusion; cervical spondylotic myelopathy; cervical laminectomy and fusion
• ISSN: 2192-5682; 2192-5690
• DOI: 10.1177/2192568220976092

Study Design:
Retrospective Cohort.
Objective:
To compare the short-term outcomes for Laminoplasty, Laminectomy/fusion, and ACDF.
Methods:
We utilized a prospectively-collected, multi-center national database with a propensity score matching algorithm to compare the short-term outcomes for laminoplasty, laminectomy/fusion, and multi-level (>3) ACDF (with and without corpectomy). Bivariate analyses involved both chi-square/fisher exact test and t-test/ANOVA on perioperative factors. Multivariate analyses were performed to determined independent risk factors for short term outcomes.
Results:
546 patients remained after propensity score matching, with 182 patients in each cohort. ACDF required the longest operative time 188 ± 79 versus laminectomy/fusion (169 ± 75, p = 0.017), and laminoplasty (167 ± 66, p = 0.004). ACDF required the shortest hospital stay (LOS ≥ 2: ACDF 56.6%, laminoplasty 89.6%, laminectomy/fusion 93.4%, p < 0.05). ACDF had lower overall complications (ACDF 3.9%, laminoplasty 7.7%, laminectomy/fusion 11.5%, p < 0.05), mortality (ACDF 0%, laminoplasty 0.55%, laminectomy/fusion 2.2%, p < 0.05), and unplanned readmissions (ACDF 4.4%, laminoplasty 4.4%, laminectomy/fusion 9.9%, p < 0.05). No significant differences were seen in the other outcomes including DVT/PT, acute renal failure, UTI, stroke, cardiac complications, or sepsis. In the multivariate analysis, laminectomy/fusion (OR 17, reference: ACDF) and laminoplasty (OR10, reference: ACDF) were strong independent risk factors for LOS ≥ 2 days. Laminectomy/fusion (OR 3.2, reference: ACDF) was an independent predictor for any adverse events 30-days after surgery.
Conclusions:
Laminectomy/fusion carries the highest risk for morbidity, mortality, and unplanned readmissions in the short-term postoperative period. Laminoplasty and ACDF cases carry similar short-term complications risks. ACDF is significantly associated with the longest operative duration and shortest LOS without an increase in individual or overall complications, readmissions, or reoperations