The following is a summary of “Comparison of Surgical Outcomes Between Anterior and Posterior Cervical Fusions Stratified by Levels Decompressed,” published in the June 2023 issue of Spinal Disorders and Techniques by Bajouri et al.
The study design used was a retrospective design. Using a national database, compare the outcomes of 1-, 2-, 3-, and 4- level anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) procedures. The outcomes of surgical procedures involving 3- or 4-level ACDF and PCF cases need to be more adequately described. As there are instances in which ACDF and PCF can be utilized, it is essential to evaluate the risks and benefits of both procedures. Using current procedural terminology identifiers, patients who underwent ACDF or PCF between 2010 and 2020 were identified in PearlDiver. Excluded were surgeries performed for infectious, traumatic, or malignant causes.
Reoperations and readmissions within 90 days were queried. ICD-9/10 billing codes were used to consolidate information on surgical complications and transfusions. After matching ACDF and PCF procedures by age, sex, Charlson Comorbidity Index, and several fused levels, the outcomes above were compared. In total, 31,301 PCFs and 110,526 ACDFs were discovered. A total of 30,353 ACDF and PCF procedures were compared after matching for age, gender, and Charlson Comorbidity Index. Three- and four-level PCFs were associated with a higher incidence of 90-day postoperative surgical complications than ACDF (OR = 2.40 and 2.87, respectively; P 0.001). In addition, 90-day readmission rates were higher in 3-level PCF than in 3-level ACDF (OR=1.24, P<0.001).
Both 3- and 4-level PCFs required more transfusions 90 days after surgery (OR = 2.44 and 18.80, respectively; P< 0.001). Reoperation rates at two years were higher for 3-level PCF procedures than 3-level ACDF procedures (OR = 1.22; P =0.01). Compared to 3-4-level PCF, patients who underwent 3-4-level ACDF had lower readmission rates, blood transfusions, and postoperative complications. ACDF may be associated with less short-term morbidity in cases of 3-4-level pathology with clinical equivalence regarding approach; however, data on fusion rates and adjacent level disease are required.
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