Anterior Decompression With Fusion Group Research Articles

Comparison of Perioperative Complications in Anterior Decompression With Fusion and Posterior Decompression With Fusion for Cervical Spondylotic Myelopathy: Propensity Score Matching Analysis Using a Nationwide Inpatient Database.

A retrospective cohort study with a national inpatient database. This study aimed to research the perioperative complication rates of cervical spondylotic myelopathy (CSM) patients who underwent anterior decompression with fusion (ADF) and posterior decompression with fusion (PDF) using a large national inpatient database and propensity score matching (PSM) analysis. There are several ways to successfully achieve surgical spinal decompression in CSM patients; however, evidence of the systemic complications and reoperation rates in ADF and PDF is lacking. We identified patients who were hospitalized for CSM and underwent either ADF or PDF from 2010 to 2016 using the Japanese Diagnosis Procedure Combination database. In the ADF and PDF groups, we compared postoperative complications (systemic and local), medical costs during hospitalization, and mortality before and after PSM. In addition, multivariate regression analysis was performed to identify risk factors for perioperative systemic complications. A total of 1013 matched pairs were made after PSM. More perioperative systemic complications were detected in the ADF group than in the PDF group (at least 1 complication: ADF vs. PDF: 15.2% vs. 12.0%, P=0.038), especially for respiratory failure (1.4% vs. 0.4%, P=0.018), pneumonia (1.9% vs. 0.5%, P=0.004), and dysphagia (3.0% vs. 1.1%, P=0.003). The costs were ~$8000 higher (P<0.001) and the length of hospital stay was almost 5 days longer (P<0.001) in the PDF group. The risk factors for perioperative systemic complications in ADF were high age, low body mass index, and preoperative respiratory disease, and the factors in PDF were high body mass index and preoperative renal disease. More systemic complications, especially respiratory events, were more frequently observed in the ADF group, while the medical costs were higher and the hospital stay was longer in the PDF group. Level III.

Comparison of perioperative complications in anterior decompression with fusion and posterior decompression with fusion for thoracic ossification of the posterior longitudinal ligament -a retrospective cohort study using a nationwide inpatient database

BackgroundThoracic ossification of the posterior longitudinal ligament (T-OPLL) is a rare disease, which can cause spinal cord compression leading to various neurological symptoms. There are limited treatment options for T-OPLL, surgery is generally considered the only effective treatment. However, few studies have investigated surgical complications in patients with T-OPLL, and there are no data regarding surgical risks in anterior decompression with fusion (ADF) when compared with posterior decompression with fusion (PDF) for T-OPLL. MethodsPatients who were diagnosed as T-OPLL and underwent ADF via the anterior approach and PDF via the posterior approach from April 1, 2012 to March 31, 2018, were extracted from the Diagnosis Procedure Combination (DPC) database. We analyzed perioperative systemic and local complication rates after ADF and PDF and compared them using propensity score matching (PSM) method. In each of the two groups, we investigated the details of length of stay, costs, mortality, and discharge destination. ResultsIn total 1344 patients (ADF: 88 patients, PDF: 1256 patients), 176 patients were investigated after PSM (88 pairs). While the incidence of overall systemic complication was significantly higher in the ADF group (ADF/PDF: 25.0%/8.0%, P = 0.002), there was no significant difference in the overall local complication rate (15.9%/19.3%, P = 0.55). Specifically, respiratory complications were more frequently observed in the ADF group (9.1%/0%, P = 0.004), however, other systemic and local complications did not differ significantly between the two groups. The length of stay was 1.7 times longer (P < 0.001) and the medical costs were 1.4 times higher (P < 0.001) in patients with perioperative complications, compared to those without perioperative complications. ConclusionWe demonstrated the perioperative complications of ADF and PDF in patients with T-OPLL using a large national database. ADF showed a higher incidence of respiratory complications. Development of perioperative complications was associated with longer hospital stay and higher medical costs.

A Prospective Cohort Study of Dysphagia After Subaxial Cervical Spine Surgery.

Prospective observational cohort study. To prospectively examine dysphagia after subaxial cervical spine surgery. Although dysphagia after anterior cervical spine surgery is common and well-studied, it has rarely been examined in posterior subaxial cervical spine surgery. This study analyzed 191 consecutive patients (132 male, 59 female; mean age, 64.9 yrs) who underwent subaxial cervical spine surgery for degenerative disease and completed 1 year of follow-up. Anterior decompression with fusion (ADF) was performed in 87 patients, posterior decompression with fusion (PDF) in 21, and laminoplasty (LAMP) in 83. Dysphagia was evaluated by a self-administered questionnaire using the Bazaz dysphagia scale before, 6 months, and 1 year after surgery. Diagnosis, levels and number of operative segments, C2-7 lordotic angle (CL), O-C2 angle (OC2A), C2-7 range of motion (ROM), Japanese Orthopedic Association for cervical myelopathy (C-JOA) score, and neck pain visual analog scale (VAS) were examined. Thirty-two patients (16.8%) reported dysphagia before surgery. New dysphagia after surgery, defined as more than or equal to 1 grade worsening of the Bazaz score after surgery compared with the preoperative status, was observed in 38 patients (19.9%) at 6 months and 32 patients (16.8%) at 1 year. The incidence of new dysphagia at 1 year was 25.3% in the ADF group, 23.8% in the PDF group, and 6.0% in the LAMP group. Fusion surgery (ACDF or PDF) and increased CL after surgery were found as risk factors at 1 year in multivariate analysis; receiver operating characteristic analysis determined a postsurgical change in CL cutoff of 5°. Fusion surgery and increased CL after surgery were risk factors for development of dysphagia after subaxial cervical spine surgery. Cervical alignment change due to anterior and posterior fusion surgery can cause postoperative dysphagia.Level of Evidence: 3.

Comparison of Clinical and Radiographic Outcomes of Laminoplasty, Anterior Decompression With Fusion, and Posterior Decompression With Fusion for Degenerative Cervical Myelopathy: A Prospective Multicenter Study.

Prospective multicenter study. The aim of this study was to compare the clinical and radiographic results of laminoplasty (LAMP), anterior decompression with fusion (ADF), and posterior decompression with fusion (PDF) for degenerative cervical myelopathy (DCM). Although ADF, LAMP, and PDF have been performed for DCM, little is known about the difference in impact of these surgical treatments on clinical and radiographic outcomes. We prospectively enrolled patients who were scheduled for surgery for DCM and compared the clinical and radiographic results of ADF, LAMP, and PDF. In total, 171 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy (C-JOA score), European Quality of Life-5 Dimensions (EQ-5D), and Neck Disability Index (NDI) scores improved in all groups postoperatively. However, no significant differences were found in C-JOA, EQ-5D, and NDI scores and recovery rate among the groups. Regarding radiographic parameters, although the operation had no effect on cervical lordosis (CL) and the C2-7 sagittal vertical axis (SVA) in the ADF group, they worsened in the LAMP and PDF group. Although there were no significant differences in any preoperative radiographic parameters within the ADF and LAMP group, CL was significantly lower and the C2-7 SVA was significantly higher in the nonrecovery group within the PDF group. Logistic regression analysis showed that preoperative lower CL was an independent risk factor for poor recovery in the PDF group. Although groups showed no significant differences in clinical outcomes, cervical alignment worsened after surgery in the LAMP and PDF groups. Within the PDF group, lower CL was an independent risk factor for poor recovery. Therefore, the indications for PDF in DCM patients with preoperative kyphotic alignment should be carefully considered. 3.

A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical spondylotic myelopathy

BackgroundThe optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial because there are few comprehensive studies that have investigated the surgical methods. Therefore, we conducted a systematic review and meta-analysis to evaluate evidence in the literature and to compare the surgical outcomes between anterior decompression with fusion (ADF) and laminoplasty, which are representative procedures for CSM. MethodsAn extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and laminoplasty for CSM. The language was restricted to English, and the publication period was from January 2001 to July 2019. We only included studies of CSM and excluded studies that involved patients with ossification of the posterior longitudinal ligament and treatments with posterior instrumented fusion. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, cervical alignment, surgical complications and reoperation rates. Then, a meta-analysis was performed on these surgical outcomes. ResultsNine studies were obtained, and the quality of the studies was acceptable. In the meta-analysis, the preoperative JOA score was similar between the ADF and laminoplasty groups. The postoperative JOA scores and neurological recovery rates were not different between the ADF and laminoplasty groups. ADF exhibited more favorable results than laminoplasty in terms of postoperative cervical alignment. In contrast, overall complications were more frequently observed in the ADF group than in the laminoplasty group, leading to higher rates of reoperation. However, postoperative neck pain was more frequently observed in the laminoplasty group than in the ADF group. ConclusionsThis systematic review and meta-analysis showed both the merits and shortcomings of ADF and laminoplasty. ADF and laminoplasty showed similar results in terms of neurological recovery. Postoperative cervical lordosis was better preserved with ADF than with laminoplasty. However, ADF was associated with a higher incidence of surgical complications than laminoplasty.

Comparison of Perioperative Complications in Anterior Decompression With Fusion and Posterior Decompression With Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Propensity Score Matching Analysis Using a Nation-Wide Inpatient Database.

A retrospective comparative study. To compare the perioperative complications and costs of anterior decompression with fusion (ADF) and posterior decompression with fusion (PDF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL). Surgical treatment of cervical OPLL has a high risk of various complications. ADF and PDF are effective for the treatment of cervical OPLL; however, few studies have compared the two procedures in terms of the perioperative surgical complications. Patients undergoing ADF and PDF for cervical OPLL from 2010 to 2016 were identified in a nation-wide inpatient database. We investigated systemic and local complications, length of hospital stay, costs for hospitalization, reoperation, and mortality. Propensity score was calculated from patients' characteristics and preoperative comorbidities, and one to one matching was performed. Propensity score-matching produced 854 pairs of patients who underwent ADF and PDF. The rate of at least one systemic complication was significantly higher in the ADF group (P = 0.004). The incidence rates of postoperative respiratory failure (P = 0.034) and dysphagia (P = 0.008) were significantly higher in the ADF group. The rates of pneumonia (P = 0.06) and hoarseness (P = 0.08) also tended to be higher in the ADF group. However, no difference was found in the mortality rate (P = 0.22). In the local complications, spinal fluid leakage was significantly higher in the ADF group (P < 0.001). However, blood transfusion rate was significantly higher in the PDF group (P = 0.001). Hospital stay was significantly longer in the PDF group (P < 0.001) and the cost for hospitalization was greater in the PDF group (P < 0.001). The present study demonstrated that perioperative complications, such as respiratory failure, dysphagia, and spinal fluid leakage, were more common in the ADF group. However, hospital stay was longer in the PDF group, and the cost for hospitalization was greater in the PDF group. 3.

Comparison of anterior decompression with fusion and posterior decompression with fusion for cervical spondylotic myelopathy—A systematic review and meta-analysis

BackgroundThe optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial. Recently, laminectomy/laminoplasty with instrumented fusion (LAMF) has been increasingly applied to treat CSM. However, few comprehensive studies have compared anterior decompression with fusion (ADF) and LAMF. Therefore, we conducted a meta-analysis to evaluate the evidence in the literature and to compare the surgical outcomes between the 2 procedures. Since the surgical outcomes and risks differ between patients with CSM and ossification of the posterior longitudinal ligament (OPLL) and between only posterior decompression and decompression with fusion treatments, we excluded patients with OPLL and patients with only posterior decompression in this review. MethodsAn extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and LAMF for the treatment of CSM. The language was restricted to English, and the publication period was from January 2001 to July 2019. We only included studies about CSM and excluded studies that involved patients with ossification of the posterior longitudinal ligament and with the treatment of posterior decompression without fusion. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI) scores, cervical alignment data, and surgical complications. Then, a meta-analysis was performed on these surgical outcomes. ResultsEleven studies were obtained, and the quality of the studies was acceptable. In the meta-analysis, the pre- and postoperative JOA scores were similar between the ADF and LAMF groups. The ADF group exhibited more favorable results than the LAMF group in terms of postoperative cervical alignment and the NDI. Overall complications were similar between the ADF and LAMF groups; however, C5 palsy was more frequently observed in the LAMF group than in the ADF group. ConclusionsWhile the ADF and LAMF groups demonstrated similar results in terms of neurological recovery, postoperative cervical lordosis and NDI scores were more favorable with ADF than with LAMF. The overall complication rate was similar between the ADF and LAMF groups. Surgeons should understand the merits and shortcomings of both procedures when deciding on a surgical procedure.

Comparison of the middle-term follow-up results between anterior decompression with fusion and posterior open-door laminoplasty for treatment of multi-level cervical spondylotic myelopathy

Objective To compare the medium-term clinical and radiologic outcomes between anterior decompression with fusion (ADF) and posterior open-door laminoplasty (LAMP) in the treatment of multi-level cervical spondylotic myelopathy (MCSM). Methods Data of 121 patients meeting to inclusion criteria from October 2011 to February 2016 were retrospectively analyzed. All the patients were treated with ADF (ADF group, n=57) or LAMP (LAMP group, n=64) for MCSM. There were 39 males and 18 females in ADF group, aged from 35 to 77 years, with an average age of 58.8±10.1 years. And there were 64 cases in LAMP group, including 48 males and 16 females, aged from 28 to 82 years, with an average of 60.6±12.2 years. The operation time and blood loss were recorded. The clinical efficacy was evaluated by Japanese Orthopaedic Association Scores (JOA), improvement rate and visual analogue scale (VAS) before operation, 1, 3, 6, 12 and 24 months after operation and at the latest follow-up. At the same time, sagittal alignment of the C2-C7 lordotic angle and range of motion (ROM) in flexion and extension on plain X-rays was measured. Residual anterior compression to the spinal cord (ACS) in LAMP group on MRI was investigated. The incidence of complications such as axial symptoms and C5 nerve root paralysis were recorded. Results The average follow-up period was 25.6±3.8 months in ADF group and 27.3±4.1 months in LAMP group. Demographics were similar between the two groups. The mean JOA scores in ADF group increased from preoperative 8.25±2.33 to 14.62±3.15 at the latest follow-up, with an average recovery rate of 72.81%±11.32%. The mean JOA scores in LAMP group increased from preoperative 8.84±3.65 to 12.97±4.32 at the latest follow-up, with an average recovery rate of 66.54%±14.75%. The difference between two groups was statistically significant. Both of the VAS scores in the two groups decreased significantly at 1 month after the surgery, but the difference between the ADF group (1.92±0.75) and the LAMP group (2.78±0.68) was statistically significant (t=2.364, P=0.021). There was no significant difference in VAS score between the two groups at 3 months after operation. Cervical lordosis of ADF group increased from 15.3°±7.6° to 19.2°±5.7°, while that of LAMP group decreased from 16.8°±8.3° to 13.6°±4.3°. There was significant difference in cervical curvature between the two groups at the latest follow-up. Both two groups exhibited decreased cervical ROM, 15.2°±3.6° and 18.1°±4.1°, respectively, and the difference between two groups was statistically significant (t=3.392, P=0.000) . At the latest follow-up, the incidence of complication was 35.1% in ADF group and 20.3% in LAMP group, and the difference between two groups has no statistically significant. The LAMP group was divided into two subgroups: (1) ACS(+)(n=11) comprising patients who had ACS after surgery, and (2) ACS(-) (n=53) comprising patients without ACS. At the latest follow-up, the average JOA score of patients with anterior residual compression of spinal cord was 10.85±5.46, while the average JOA score of patients without anterior residual compression of spinal cord was 14.18±4.52. The recovery rate differed significantly between the ACS(+) and ACS(-) groups, 40.52%±9.76% and 70.38%±10.52%, respectively. Also at the latest follow-up, the cervical curvature, ROM and ROM loss angle were 10.2°±7.3°, 15.6°±6.7° and 11.8°±8.3° in the group with anterior residual compression of spinal cord, respectively. The groups without anterior residual compression of spinal cord were 15.8°±6.5°, 20.4°±10.2° and 8.8°±6.8°, respectively. Conclusion Both ADF and LAMP groups provided good outcomes at 2-year time-point whereas ADF could achieve more satisfactory outcomes and better sagittal alignment at the middle-term. ADF can remove the compression directly, maintain the curvature of cervical vertebra effectively and restore the nerve function well. The clinical outcomes after LAMP could be influenced by ACS, due to the reduction of cervical curvature and the decrease of cervical range of motion. Key words: Cervical vertebrae; Spinal cord compression; Spinal fusion

Perioperative complications of anterior decompression with fusion versus laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament: propensity score matching analysis using a nation-wide inpatient database

BACKGROUND CONTEXTSurgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications. PURPOSETo compare the perioperative complications post-ADF and LAMP for cervical OPLL using a large national inpatient database. STUDY DESIGNA retrospective cohort study with propensity score matching analysis. PATIENT SAMPLEOverall, 8,718 (ADF/LAMP:1,333/7,485) patients who underwent surgery for cervical OPLL from April 1, 2010 to March 31, 2016 in hospitals using the diagnosis procedure combination were analyzed. OUTCOME MEASURESThe occurrence of postoperative complications during hospitalization. METHODSWe compared the perioperative systemic and local complications, reoperation rates, and costs between ADF and LAMP using propensity score matching analysis. RESULTSOne-to-one matching resulted in 1,192 pairs of patients who underwent ADF and LAMP. The postoperative cardiovascular event rate was significantly higher (ADF/LAMP=1.9/0.8%, p=.013) in the ADF group. The incidence rates of dysphagia (similarly, 2.4/0.2%, p<.001), pneumonia (1.0/0.3%, p=.045), and spinal fluid leakage (2.4/0.4%, p<.001) were also higher in the ADF group, even after matching. The costs were also higher in the ADF group. However, surgical site infection (2.0/3.4%, p=.033) was significantly lower in the ADF group. No significant difference in the reoperation rates was found between the groups. CONCLUSIONThe present study, using a large nationwide database, demonstrated that perioperative complications were more common in the ADF group, but that surgical site infection (SSI) was more frequently observed in the LAMP group.

Anterior decompression with fusion versus posterior decompression with fusion for massive cervical ossification of the posterior longitudinal ligament with a ≥50% canal occupying ratio: a multicenter retrospective study

Background ContextPrevious studies have shown that compared with laminoplasty, anterior decompression with fusion (ADF) is superior for postoperative neurologic improvement in patients with massive cervical ossification of the posterior longitudinal ligament (OPLL) with a ≥50% canal occupying ratio. However, it is unknown which method, ADF or posterior decompression with fusion (PDF), is more effective for the treatment of massive OPLL. PurposeThis study aimed to investigate the surgical outcomes of ADF and PDF for the treatment of massive OPLL. Study DesignA multicenter retrospective case-control study was carried out. Patient SampleA total of 61 OPLL patients with a ≥50% canal occupying ratio were included in this study. The mean age of the patients was 60.9 years (49 males and 12 females); 39 patients (31 males and 8 females, average age 61.1 years) underwent ADF, and 22 patients underwent PDF (18 males and 4 females, average age 60.6 years). Outcome MeasuresThe data collected from both groups included age, gender, neurologic symptoms evaluated based on the Japanese Orthopedic Association score, neck pain assessed using the visual analogue scale, and radiographic parameters, including cervical lordosis and the OPLL canal occupying ratio. MethodsClinical and radiological outcomes were compared between the ADF and PDF groups with a minimum of 2 years follow-up. ResultsThere were no significant differences in the postoperative neurologic recovery rate between the two groups. However, in patients with kyphotic alignment (C2–C7 angle <0 degrees), the recovery rate was higher in the ADF group. Postoperative cervical pain was greater in the PDF group. The improvement in cervical alignment at C2–C7 was greater in the ADF group. The operating time was longer in the ADF group, whereas the intraoperative blood loss was greater in the PDF group. Approach-related complications were more frequently observed in the ADF group than in the PDF group. ConclusionsThe present study demonstrated that the postoperative recovery rate was similar in the ADF and PDF group. In patients with massive OPLL with kyphotic alignment, neurologic recovery rate in the ADF was superior to that in the PDF (in situ fusion). Additionally, postoperative neck pain was less severe in the ADF group. However, the occurrence of perioperative complications was more common in the ADF group.

Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty.

Cervical sagittal balance has received increased attention as an important determinant of radiological and clinical outcomes. However, no prospective studies have compared the impact of cervical sagittal balance between anterior and posterior surgeries. We previously conducted a prospective study comparing anterior decompression with fusion (ADF) and laminoplasty (LAMP) for degenerative cervical myelopathy (DCM) and reported; however, analysis of cervical alignment within the concept of sagittal balance has yet to be performed, because that concept has recently been proposed. This study aimed to review this prospective cohort, specifically focusing on cervical sagittal balance. We prospectively performed ADF or LAMP for DCM patients based on the year of enrollment: ADF was performed in odd-numbered years and LAMP in even-numbered years. Cervical lateral X-ray images taken in the neutral standing position were evaluated preoperatively and at a 1-year follow-up. The radiographic measurements included the following: (1) CL (cervical lordosis: C2-7 lordotic angle), (2) CGH (center of gravity of the head)-C7 SVA (sagittal vertical axis), and (3) C7 slope. The clinical results were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (C-JOA score). We analyzed the data for 66 patients (ADF n=28, LAMP n=38). While the CL and CGH-C7 SVA in the ADF were unchanged after the operation, those in the LAMP group worsened, especially in patients with preoperative cervical sagittal imbalance. The C7 slopes were not affected by the operation in either group. The postoperative decreases in the CL in the LAMP group correlated with the preoperative CGH-C7 SVA (r=0.618, P<0.01), but those in ADF group did not. In patients with preoperative cervical sagittal imbalance (CGH-C7 SVA ≥40mm), the recovery rate of the C-JOA score in the ADF group was superior to that in the LAMP group (67.3 vs. 39.8%). In contrast, for patients without cervical sagittal imbalance, the recovery rate of the C-JOA score showed no significant difference between the ADF and LAMP groups (64.5 vs. 58.7%). Postoperative cervical sagittal alignment and balance were maintained after ADF but deteriorated following LAMP, especially in patients with preoperative CGH-C7 SVA ≥40mm. In these patients, neurological recovery after LAMP was unsatisfactory. LAMP is not suitable for degenerative cervical myelopathy patients with preoperative cervical sagittal imbalance.