Primary anterior cervical fusion has lower in-hospital complication rates and deaths than posterior cervical fusion
If both approaches are reasonable beforehand, patients undergoing operations to fuse the cervical spine do better after anterior cervical spine fusion (ACDF) than posterior cervical spine fusion (PCDF), according to a new study. Fusion of the cervical spine has become more common in the past 3 decades for the treatment of trauma-fractured cervical vertebrae or degenerative disease that do not respond to other stabilization techniques.
Researchers at Weill Medical College of Cornell University found in their study of 228,113 hospital admissions that involved primary cervical spine fusion, that the hospital length of stay (LOS) was significantly longer for PCDF patients than ACDF patients (7.8 days vs. 2.4 days). Patients undergoing ACDF had a fourth the incidence of procedure-related complications (4.14 percent) than did PCDF patients (15.35 percent), and lower in-hospital mortality (0.26 vs. 1.44 percent).
When the researchers controlled for coexisting medical conditions and other demographic variables, PCDF patients were at twice the risk of perioperative mortality than ACDF patients. Other mortality risk factors for cervical spine fusion found by the study were age 65 years or older or being male. A number of coexisting conditions (particularly kidney disease and pulmonary circulatory disease) were associated with at least a threefold increased risk of perioperative mortality for patients who underwent cervical spine fusion. The authors caution, however, that higher risk associated with PCDF may be influenced by the fact that patients undergoing this procedure compared with ACDF often require more extensive fusion. This is a factor not accounted for in the study due to the lack of such information in the database.
Data on patients who underwent spinal surgery for cervical fusion came from the National Inpatient Samples for 1998 through 2006 of AHRQ's Healthcare Cost and Utilization Project. The study was funded in part by the Agency for Healthcare Research and Quality (HS16075) to Cornell University's Center for Education and Research on Therapeutics (CERT).
For more information on the CERTs program, visit http://www.certs.hhs.gov.
More details are in "Increased in-hospital complications after primary posterior versus primary anterior cervical fusion," by Stavros G. Memtsoudis, M.D., Ph.D., Alexander Hughes, M.D., Yan Ma, Ph.D., and others in the March 2011 Clinical Orthopaedics and Related Research 469(3), pp. 649-657. An Erratum was published in the May 2011 Clinical Orthopaedics and Related Research 469(5), pp. 1502-1504.
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