Wednesday, September 26, 2018 3:35 PM – 5:05 PM How to Avoid Complications: 100. Anterior versus posterior decompression for degenerative thoracic spine diseases: a comparison of complications

Abstract

BACKGROUND CONTEXT Although posterior decompression is the most common approach for surgical treatment of degenerative thoracic spine disease, anterior approach is gaining interest due to its advantage in disc visualization. Considering the substantial similarity in neurologic outcomes following the two approaches, complication rates seem to be the key determinants in resolving the controversy over the optimal approach. PURPOSE To compare the complication rates between anterior and posterior decompression for degenerative thoracic spine disease. STUDY DESIGN/SETTING Retrospective database. PATIENT SAMPLE Patients with degenerative thoracic spine disease who had undergone anterior or posterior decompression between 2007 and 2015. OUTCOME MEASURES Charlson Comorbidity Index (CCI) as a broad measure of comorbidity; Intra-operative complications, including accidental organ puncture or laceration, hemorrhage and dural laceration; and major medical complications on the day of surgery, one month and three months after the surgery, including cardiovascular, central nervous system, infectious, respiratory and wound complications as well as organ failure and minor complications. METHODS A private insurance database (Humana) containing the medical records of over 68 million patients in United States was queried using the PearlDiver Patient Records Database (PearlDiver Technologies, Colorado Springs, CO, USA). Patients who had undergone anterior or posterior thoracic decompression were identified using the Current Procedural Terminology codes. Subsequently, records were screened for patients with degenerative diagnoses using the International Classification of Diseases 9th edition codes, and patients diagnosed with spinal neoplasm, trauma, fracture and infection were excluded. CCI was compared between groups using the Mann-Whitney U test. Incidence rates of complications were compared between the two approaches using the Chi-square statistics, and crude odds ratios (OR) with 95% confidence intervals (CI) were reported. RESULTS A total of 1,495 patients were included in this study, consisting of 1,030 patients in the posterior group and 465 patients in the anterior group. CCI was significantly higher in the posterior group (Md=2, IQR: 1-4) compared to the anterior group (Md=2, IQR: 2-2, p CONCLUSIONS Despite having a lower overall comorbidity score, patients with degenerative thoracic spine diseases undergoing anterior decompression were more likely to develop intraoperative, respiratory and minor complications when compared to the posterior approach. High rates of respiratory complications following the anterior approach underline the importance of special respiratory care for these patients. Future studies may focus on predictive factors of respiratory compromise following thoracic decompression, aiming to identify the patients at risk who may benefit from posterior decompression. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.