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- Title
What factors influence surgical decision-making in anterior versus posterior surgery for cervical myelopathy? A QOD analysis.
- Authors
Park, Christine; Shaffrey, Christopher I.; Than, Khoi D.; Michalopoulos, Giorgos D.; El Sammak, Sally; Chan, Andrew K.; Bisson, Erica F.; Sherrod, Brandon A.; Asher, Anthony L.; Coric, Domagoj; Potts, Eric A.; Foley, Kevin T.; Wang, Michael Y.; Kai-Ming Fu; Virk, Michael S.; Knightly, John J.; Meyer, Scott; Park, Paul; Upadhyaya, Cheerag; Shaffrey, Mark E.
- Abstract
OBJECTIVE The aim of this study was to explore the preoperative patient characteristics that affect surgical decisionmaking when selecting an anterior or posterior operative approach in patients diagnosed with cervical spondylotic myelopathy (CSM). METHODS This was a multi-institutional, retrospective study of the prospective Quality Outcomes Database (QOD) Cervical Spondylotic Myelopathy module. Patients aged 18 years or older diagnosed with primary CSM who underwent multilevel (≥ 2-level) elective surgery were included. Demographics and baseline clinical characteristics were collected. RESULTS Of the 841 patients with CSM in the database, 492 (58.5%) underwent multilevel anterior surgery and 349 (41.5%) underwent multilevel posterior surgery. Surgeons more often performed a posterior surgical approach in older patients (mean 64.8 ± 10.6 vs 58.5 ± 11.1 years, p < 0.001) and those with a higher American Society of Anesthesiologists class (class III or IV: 52.4% vs 46.3%, p = 0.003), a higher rate of motor deficit (67.0% vs 58.7%, p = 0.014), worse myelopathy (mean modified Japanese Orthopaedic Association score 11.4 ± 3.1 vs 12.4 ± 2.6, p < 0.001), and more levels treated (4.3 ± 1.3 vs 2.4 ± 0.6, p < 0.001). On the other hand, surgeons more frequently performed an anterior surgical approach when patients were employed (47.2% vs 23.2%, p < 0.001) and had intervertebral disc herniation as an underlying pathology (30.7% vs 9.2%, p < 0.001). CONCLUSIONS The selection of approach for patients with CSM depends on patient demographics and symptomology. Posterior surgery was performed in patients who were older and had worse systemic disease, increased myelopathy, and greater levels of stenosis. Anterior surgery was more often performed in patients who were employed and had intervertebral disc herniation.
- Publication
Journal of Neurosurgery: Spine, 2024, Vol 40, Issue 2, p206
- ISSN
1547-5654
- Publication type
Article
- DOI
10.3171/2023.8.SPINE23194