Short-term Outcomes Following Cervical Laminoplasty and Decompression and Fusion with Instrumentation.

Authors:
Anthony Boniello
Anthony Boniello
NYU Hospital for Joint Diseases
Samantha Horn
Samantha Horn
NYU Hospital for Joint Diseases
New York | United States
Cole A Bortz
Cole A Bortz
NYU Langone Orthopedic Hospital
Avery E Brown
Avery E Brown
University of Nevada School of Medicine
Shanghai | China
Haddy Alas
Haddy Alas
SUNY Downstate College of Medicine
United States

Spine (Phila Pa 1976) 2019 Apr 8. Epub 2019 Apr 8.

Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA.

Study Design: Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2010-2015.

Objective: Investigate which short-term outcomes differ for cervical laminoplasty and laminectomy and fusion surgeries.

Summary Of Background Data: Conflicting reports exist in spine literature regarding short-term outcomes following cervical laminoplasty and posterior laminectomy and fusion. The objective of this study was to compare the 30-day outcomes for these two treatment groups for multilevel cervical pathology.

Methods: Patients who underwent cervical laminoplasty or posterior laminectomy and fusion were identified in NSQIP based on Current Procedural Terminology (CPT) code: Laminoplasty 63050 and 63051, Posterior cervical laminectomy 63015 and 63045, and instrumentation 22842. Propensity-adjusted multivariate regressions assessed differences in postoperative length of stay, adverse events, discharge disposition, and readmission.

Results: 3796 patients were included: 2397 (63%) underwent cervical laminectomy and fusion and 1399 (37%) underwent cervical laminoplasty. Both groups were similar in age, gender, BMI, ASA, CCI and had similar rates of malnutrition, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, and history for steroid use. Age > 70 and age <50 were not associated with one treatment group over the other (P>0.05). Compared with laminoplasty patients, laminectomy and fusion patients had increased lengths of stay (LOS) (4.5 vs 3.7 days, P<0.01) and increased rates of adverse events (41.7 vs 35.9%, P < 0.01), discharge to rehab (16.4 vs 8.6%, P < 0.01) and skilled nursing facilities (12.2 vs 9.7%, P = 0.02), and readmission (6.2 vs 4.5%, P = 0.05). Both groups experienced similar rates of death, pulmonary embolus, deep vein thrombosis, deep and superficial surgical site infection, and reoperation (P > 0.05 for all).

Conclusions: Posterior cervical laminectomy and fusion patients were found to have increased LOS, readmissions, and complications despite having similar pre-op demographics and comorbidities. Patients and surgeons should consider these risks when considering surgical treatment for cervical pathology.

Level Of Evidence: 3.

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Source
http://dx.doi.org/10.1097/BRS.0000000000003057DOI Listing
April 2019
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