In patients with diffuse cervical spondylosis, posterior fusion is associated with a significantly higher rate of complications and resource utilization than anterior fusion, according to a report published in the January issue of The Spine Journal.
Mohammed F. Shamji, M.D., of the Ottawa Hospital in Ottawa, Ontario, Canada, and colleagues compared outcomes in 6,091 patients who underwent anterior fusion and 2,457 patients who underwent posterior fusion between 2003 and 2005.
Compared to anterior fusion, the researchers found that posterior fusion was associated with significantly higher rates of respiratory complications (3.54 percent versus 1.26 percent), postoperative infections (0.98 percent versus 0.13 percent), hematomas (2.12 percent versus 0.80 percent) and transfusions (7.20 percent versus 1.38 percent). They also found that resource utilization, including length of hospital stay, inflation-adjusted cost and the likelihood of being discharged to an assisted-living facility, was nearly double for those who underwent posterior fusion. A posterior approach was associated with a significantly higher inflation-adjusted cost ($71,632 versus $43,217).
“”The results reveal the impact of surgical approach on the incidence of such morbidity, with significant outcome differences observed even after controlling for important observed demographic covariates such as age, presence of myelopathy, and Deyo comorbidity score,”” the authors conclude. “”For patients in whom disease pathoanatomy supports that a multilevel anterior cervical spine fusion could be appropriate, these data suggest that the procedure can be performed with low perioperative morbidity.””
Source: Modern Medicine