Perioperative and Delayed Complications Associated with the Surgical Treatment of Cervical Spondylotic Myelopathy Based on 302 Patients from the AOSpine North America Cervical Spondylotic Myelopathy Study

Details

• Personal Author:
  Arnold PM ; Banco RJ ; Bono CM ; Brodke DS ; Chapman JR ; Dekutoski MB ; Fehlings MG ; Gokaslan ZL ; Janssen ME ; Kopjar B ; Massicotte EM ; Sasso RC ; Shaffrey CI ; Smith JS ; Vaccaro AR ; Woodard EJ ; Yoon ST
• Description:
  Object: Rates of complications associated with the surgical treatment of cervical spondylotic myelopathy (CSM) are not clear. Appreciating these risks is important for patient counseling and quality improvement. The authors sought to assess the rates of and risk factors associated with perioperative and delayed complications associated with the surgical treatment of CSM. Methods: Data from the AOSpine North America Cervical Spondylotic Myelopathy Study, a prospective, multicenter study, were analyzed. Outcomes data, including adverse events, were collected in a standardized manner and externally monitored. Rates of perioperative complications (within 30 days of surgery) and delayed complications (31 days to 2 years following surgery) were tabulated and stratified based on clinical factors. Results: The study enrolled 302 patients (mean age 57 years, range 29-86) years. Of 332 reported adverse events, 73 were classified as perioperative complications (25 major and 48 minor) in 47 patients (overall perioperative complication rate of 15.6%). The most common perioperative complications included minor cardiopulmonary events (3.0%), dysphagia (3.0%), and superficial wound infection (2.3%). Perioperative worsening of myelopathy was reported in 4 patients (1.3%). Based on 275 patients who completed 2 years of follow-up, there were 14 delayed complications (8 minor, 6 major) in 12 patients, for an overall delayed complication rate of 4.4%. Of patients treated with anterior-only (n = 176), posterior-only (n = 107), and combined anterior-posterior (n = 19) procedures, 11%, 19%, and 37%, respectively, had 1 or more perioperative complications. Compared with anterior-only approaches, posterior-only approaches had a higher rate of wound infection (0.6% vs 4.7%, p = 0.030). Dysphagia was more common with combined anterior-posterior procedures (21.1%) compared with anterior-only procedures (2.3%) or posterior-only procedures (0.9%) (p < 0.001). The incidence of C-5 radiculopathy was not associated with the surgical approach (p = 0.8). The occurrence of perioperative complications was associated with increased age (p = 0.006), combined anterior-posterior procedures (p = 0.016), increased operative time (p = 0.009), and increased operative blood loss (p = 0.005), but it was not associated with comorbidity score, body mass index, modified Japanese Orthopaedic Association score, smoking status, anterior-only versus posterior-only approach, or specific procedures. Multivariate analysis of factors associated with minor or major complications identified age (OR 1.029, 95% CI 1.002-1.057, p = 0.035) and operative time (OR 1.005, 95% CI 1.002-1.008, p = 0.001). Multivariate analysis of factors associated with major complications identified age (OR 1.054, 95% CI 1.015-1.094, p = 0.006) and combined anterior-posterior procedures (OR 5.297, 95% CI 1.626-17.256, p = 0.006). Conclusions: For the surgical treatment of CSM, the vast majority of complications were treatable and without long-term impact. Multivariate factors associated with an increased risk of complications include greater age, increased operative time, and use of combined anterior-posterior procedures. [Description provided by NIOSH]
• Subjects:
  Age Factors Musculoskeletal Diseases Musculoskeletal System Occupational Health Safety
• Keywords:
  Age Factors Author Keywords: Fusion Cervical Spondylotic Myelopathy Complication Laminoplasty Medical Treatment Neck Injuries Spinal Cord Disorders Surgery
• ISSN:
  1547-5654
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Colorado ; Georgia ; Indiana ; Kansas ; Maryland ; Massachusetts ; OSHA Region 1 ; OSHA Region 10 ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 7 ; OSHA Region 8 ; Pennsylvania ; Utah ; Virginia ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  425-432
• Volume:
  16
• Issue:
  5
• NIOSHTIC Number:
  nn:20056414
• Citation:
  J Neurosurg Spine 2012 May; 16(5):425-432
• Contact Point Address:
  Justin S. Smith, M.D., Ph.D., Department of Neurological Surgery, University of Virginia Health System, PO Box 800212, Charlottesville, Virginia 22908
• Email:
  jss7f@virginia.edu
• Federal Fiscal Year:
  2012
• Performing Organization:
  University of Washington
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  Journal of Neurosurgery: Spine
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:7b4a4cfd1009e6212754ed4420f9a4b9272131164fd49900b790488b1a9bb1d514d9674f740d17ae8eda3e3f22b823fdc5820cce17cffc0c80f29a639834ac7f
• Download URL:
  https://stacks.cdc.gov/view/cdc/214022/cdc_214022_DS1.pdf
• File Type:
  [PDF - 247.53 KB ]