PMID- 37657103 OWN - NLM STAT- Publisher LR - 20230901 IS - 1092-0684 (Electronic) IS - 1092-0684 (Linking) VI - 55 IP - 3 DP - 2023 Sep TI - Three-level ACDF versus 3-level laminectomy and fusion: are there differences in outcomes? An analysis of the Quality Outcomes Database cervical spondylotic myelopathy cohort. PG - E2 LID - 10.3171/2023.6.FOCUS23295 [doi] AB - OBJECTIVE: The authors sought to compare 3-level anterior with posterior fusion surgical procedures for the treatment of multilevel cervical spondylotic myelopathy (CSM). METHODS: The authors analyzed prospective data from the 14 highest enrolling sites of the Quality Outcomes Database CSM module. They compared 3-level anterior cervical discectomy and fusion (ACDF) and posterior cervical laminectomy and fusion (PCF) surgical procedures, excluding surgical procedures crossing the cervicothoracic junction. Rates of reaching the minimal clinically important difference (MCID) in patient-reported outcomes (PROs) were compared at 24 months postoperatively. Multivariable analyses adjusted for potential confounders elucidated in univariable analysis. RESULTS: Overall, 199 patients met the inclusion criteria: 123 ACDF (61.8%) and 76 PCF (38.2%) patients. The 24-month follow-up rates were similar (ACDF 90.2% vs PCF 92.1%, p = 0.67). Preoperatively, ACDF patients were younger (60.8 +/- 10.2 vs 65.0 +/- 10.3 years, p < 0.01), and greater proportions were privately insured (56.1% vs 36.8%, p = 0.02), actively employed (39.8% vs 22.8%, p = 0.04), and independently ambulatory (14.6% vs 31.6%, p < 0.01). Otherwise, the cohorts had equivalent baseline modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), numeric rating scale (NRS)-arm pain, NRS-neck pain, and EQ-5D scores (p > 0.05). ACDF patients had reduced hospitalization length (1.6 vs 3.9 days, p < 0.01) and a greater proportion had nonroutine discharge (7.3% vs 22.8%, p < 0.01), but they had a higher rate of postoperative dysphagia (13.5% vs 3.5%, p = 0.049). Compared with baseline values, both groups demonstrated improvements in all outcomes at 24 months (p < 0.05). In multivariable analyses, after controlling for age, insurance payor, employment status, ambulation status, and other potential clinically relevant confounders, ACDF was associated with a greater proportion of patients with maximum satisfaction on the North American Spine Society Patient Satisfaction Index (NASS) (NASS score of 1) at 24 months (69.4% vs 53.7%, OR 2.44, 95% CI 1.17-5.09, adjusted p = 0.02). Otherwise, the cohorts shared similar 24-month outcomes in terms of reaching the MCID for mJOA, NDI, NRS-arm pain, NRS-neck pain, and EQ-5D score (adjusted p > 0.05). There were no differences in the 3-month readmission (ACDF 4.1% vs PCF 3.9%, p = 0.97) and 24-month reoperation (ACDF 13.5% vs PCF 18.6%, p = 0.36) rates. CONCLUSIONS: In a cohort limited to 3-level fusion surgical procedures, ACDF was associated with reduced blood loss, shorter hospitalization length, and higher routine home discharge rates; however, PCF resulted in lower rates of postoperative dysphagia. The procedures yielded comparably significant improvements in functional status (mJOA score), neck and arm pain, neck pain-related disability, and quality of life at 3, 12, and 24 months. ACDF patients had significantly higher odds of maximum satisfaction (NASS score 1). Given comparable outcomes, patients should be counseled on each approach's complication profile to aid in surgical decision-making. FAU - Ambati, Vardhaan S AU - Ambati VS AD - 1Department of Neurological Surgery, University of California, San Francisco, California. FAU - Macki, Mohamed AU - Macki M AD - 1Department of Neurological Surgery, University of California, San Francisco, California. FAU - Chan, Andrew K AU - Chan AK AD - 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Michalopoulos, Giorgos D AU - Michalopoulos GD AD - 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Le, Vivian P AU - Le VP AD - 1Department of Neurological Surgery, University of California, San Francisco, California. AD - 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Jamieson, Alysha B AU - Jamieson AB AD - 1Department of Neurological Surgery, University of California, San Francisco, California. FAU - Chou, Dean AU - Chou D AD - 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - 4Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Gottfried, Oren N AU - Gottfried ON AD - 4Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Bisson, Erica F AU - Bisson EF AD - 5Department of Neurological Surgery, University of Utah, Salt Lake City, Utah. FAU - Asher, Anthony L AU - Asher AL AD - 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina. FAU - Coric, Domagoj AU - Coric D AD - 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina. FAU - Potts, Eric A AU - Potts EA AD - 7Goodman Campbell Brain and Spine, Indianapolis, Indiana. FAU - Foley, Kevin T AU - Foley KT AD - 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee. FAU - Wang, Michael Y AU - Wang MY AD - 9Department of Neurological Surgery, University of Miami, Florida. FAU - Fu, Kai-Ming AU - Fu KM AD - 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York. FAU - Virk, Michael S AU - Virk MS AD - 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York. FAU - Knightly, John J AU - Knightly JJ AD - 11Atlantic Neurosurgical Specialists, Morristown, New Jersey. FAU - Meyer, Scott AU - Meyer S AD - 11Atlantic Neurosurgical Specialists, Morristown, New Jersey. FAU - Park, Paul AU - Park P AD - 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee. FAU - Upadhyaya, Cheerag AU - Upadhyaya C AD - 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri. FAU - Shaffrey, Mark E AU - Shaffrey ME AD - 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. FAU - Buchholz, Avery L AU - Buchholz AL AD - 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. FAU - Tumialan, Luis M AU - Tumialan LM AD - 14Barrow Neurological Institute, Phoenix, Arizona; and. FAU - Turner, Jay D AU - Turner JD AD - 14Barrow Neurological Institute, Phoenix, Arizona; and. FAU - Sherrod, Brandon A AU - Sherrod BA AD - 5Department of Neurological Surgery, University of Utah, Salt Lake City, Utah. FAU - Haid, Regis W AU - Haid RW AD - 15Atlanta Brain and Spine Care, Atlanta, Georgia. FAU - Bydon, Mohamad AU - Bydon M AD - 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Mummaneni, Praveen V AU - Mummaneni PV AD - 1Department of Neurological Surgery, University of California, San Francisco, California. LA - eng PT - Journal Article PL - United States TA - Neurosurg Focus JT - Neurosurgical focus JID - 100896471 SB - IM OTO - NOTNLM OT - ACDF OT - CSM OT - cervical spondylotic myelopathy OT - posterior cervical laminectomy and fusion EDAT- 2023/09/01 18:41 MHDA- 2023/09/01 18:41 CRDT- 2023/09/01 17:53 PHST- 2023/05/01 00:00 [received] PHST- 2023/06/16 00:00 [accepted] PHST- 2023/09/01 18:41 [medline] PHST- 2023/09/01 18:41 [pubmed] PHST- 2023/09/01 17:53 [entrez] AID - 10.3171/2023.6.FOCUS23295 [doi] PST - ppublish SO - Neurosurg Focus. 2023 Sep;55(3):E2. doi: 10.3171/2023.6.FOCUS23295.