Comparison of Postoperative Complications and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in the Privately Insured Patient Population

Study Design: This was a large database study. Objective: The objective of this study was to compare the incidence of complications and reoperation rates between the most common surgical treatments for cervical spondylotic myelopathy (CSM): anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and posterior laminectomy and fusion (Lamifusion). Summary of Background Data: CSM is a major contributor to disability and reduced quality of life worldwide. Methods: Humana insurance database was queried for CSM diagnoses between 2007 and 2016. The initial population was divided based on the surgical treatment and matched for age, sex, and Charlson Comorbidity index. Specific postoperative complications or revisions were analyzed at individual time points. Pearson chi(2) analysis with Yate continuity correction was used. Results: Lamifusion had significantly higher rates of wound infection/disruption than ACDF or ACCF (5.03%, 2.19%, 2.29%; P = 0.0008, 0.002, respectively) as well as iatrogenic deformity (4.75%, 2.19%, 2.10%; P= 0.0036, 0.0013). Lamifusion also had a significantly higher rate of shock and same-day transfusion than ACDF (4.75%, 2.01%, P = 0.0005), circulatory complications (2.01%, <1%, P= 0.0183), and C5 palsy (4.84%, 1.74%, P< 0.0001). Compared with ACDF, Lamifusion had higher rates of hardware complication (3.29%, 2.01%, P = 0.0468), and revision surgery (8.23% 5.85%, P= 0.0395) Lamifusion had significantly lower rates of dysphagia than either ACDF (3.93% vs. 6.58%, P =0.0089) or ACCF (3.93% vs. 8.59%, P < 0.0001). When comparing ACCF to ACDF, ACCF had significantly higher rates of circulatory complications (2.38%, <1%, P=0.0053), shock/same-day transfusion (3.2%, 2.0%, P=0.59), C5 palsy (3.47%, 1.74%, P= 0.0108), and revision surgery (9.51%, 5.85%, P=0.0086). Conclusions: The data shows that posterior Lamifusion has higher overall rate of complications compared with ACDF or ACCF. Furthermore, when comparing the anterior approaches, ACDF was associated with lower rate of complication and revision. ACCF had the highest overall rate of revision surgery.