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Neurological Status Affects Morbidity in Cervical Fusion

Unable to determine if surgical approach improves outcomes

MONDAY, July 7 (HealthDay News) -- Myelopathy increases complications during cervical fusion, regardless of the surgical approach, researchers report in the July issue of the Journal of Neurosurgery: Spine.

Mohammed F. Shamji, M.D., of The Ottawa Hospital in Ontario, Canada, and colleagues examined 96,773 patients from the Nationwide Inpatient Sample database who underwent cervical fusion for degenerative disease between 1988 and 2003. Patients were classified according to surgical approach (anterior versus posterior) and preoperative neurological status (myelopathic versus non-myelopathic). Logistic regression was used to evaluate group effects on selected postoperative complications.

Patients undergoing an anterior surgical approach without myelopathy experienced the lowest rates of complications, and patients undergoing posterior approaches with myelopathy experienced the highest complication rates, the researchers report. Resource utilization displayed similar trends with an anterior approach without myelopathy having a mean cost of $20,639 and 1.95 in-hospital days, versus myelopathic patients who incurred higher costs (mean $28,581) and longer length of stays (mean 3.42 days). Direct comparisons of surgical approach are not possible because of the heterogeneity of the patient's underlying structure and alignment of the cervical spine, the investigators note. Overall, preoperative myelopathy, controlling for surgical approach in the logistic regression analysis, was prognostic of death, pneumonia, transfusion, infection, length of stay and post-hospital disposition.

"For a given surgical approach, patients with pre-existing myelopathy encounter heightened mortality rate, morbidity and resource utilization during cervical spine fusion," the authors conclude. "This study has systematically described the complications encountered in a large group of patients undergoing cervical fusion."

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