31. A comparison of various surgical treatments for cervical spondylotic myelopathy: a propensity score matched analysis

Abstract

BACKGROUND CONTEXT Several established options for the treatment of cervical spondylotic myelopathy (CSM) exist, but the ideal surgical technique remains elusive due to the lack of comprehensive comparative analyses. PURPOSE To examine the short-term outcomes between ACDF, laminectomy and fusion (LF), and laminoplasty (LP) for patients with CSM. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Adult patients with a primary diagnosis of CSM who underwent ACDF, LF, vs LP from 2016 to 2017. OUTCOME MEASURES Perioperative complications, readmissions, and reoperations. METHODS A prospectively-collected, multicentered national database with a propensity score matching to compare the short-term outcomes for LP, LF, and ACDF. Bivariate analyses involved both chi-square/Fisher exact test and t-tests on perioperative factors. Multivariate analyses were performed to determined independent risk factors for short term outcomes. RESULTS A total of 564 patients remained after propensity score matching, with 188 patients in each cohort. The any complication rate was highest in LF (11.2%) vs ACDF (4.3%) and LP (7.5%), p=0.066. LF group was more likely to undergo a reoperation within 30 days than LP patients (OR5, 4.3% vs 1.1%, p=0.042). Compared to ACDF, LP were more likely to have LOS>1 day (OR12, 88.3% vs 37.8%, p CONCLUSIONS LF is associated with the highest morbidity, readmission, and reoperation. Top reoperation reasons were wound complications and persistent myelopathic symptoms. LP had the lowest readmission rates; however, longer LOS than ACDF likely related to the longer operative time and greater proportion of patients requiring discharge to a skilled nursing facility. In early postop, LF carries the highest risk for complications requiring reoperation. LP is associated with longer LOS than ACDF without an increase in individual/overall complications, readmissions, and reoperations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.