Davis Martin, Ryan Schroeder, Collin Toups, Clifton Daigle, Matthew Spitchley, Claudia Leonardi, Berje Shammassian, Amit K Bhandutia
{"title":"Comparing ACDF Outcomes by Cervical Spine Level: A Single Center Retrospective Cohort Study.","authors":"Davis Martin, Ryan Schroeder, Collin Toups, Clifton Daigle, Matthew Spitchley, Claudia Leonardi, Berje Shammassian, Amit K Bhandutia","doi":"10.14444/8657","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Previous research suggests a relationship between complications associated with anterior cervical discectomy and fusion and level involvement; however, there is limited research comparing postoperative outcomes of upper cervical fusions (UCFs) with middle-to-lower cervical fusions (MLCFs). This study aims to compare the outcomes of UCF with MLCF.</p><p><strong>Methods: </strong>A retrospective medical record review was conducted on 835 anterior cervical discectomy and fusion patients from 2012 to 2022. Patients were classified as UCF, defined as inclusion of C3 to C4 disc space, or MLCF, defined as lacking C3 to C4 disc space. Demographics were compared using <i>χ</i> <sup>2</sup> or Fisher exact tests. Clinical characteristics were compared in univariable analysis using <i>χ</i> <sup>2</sup> tests, linear-mixed effects models, or generalized linear-mixed models depending on distribution. Significant pre- and intraoperative characteristics were included in multivariable models to minimize confounding.</p><p><strong>Results: </strong>Of the 835 patients included, 562 underwent MLCF and 281 underwent UCF. Median follow-up time was 211 days for UCF and 200 days for MLCF. UCF led to a 1.5-day longer length of stay in both univariable (1.5 vs 3.1, <i>P</i> < 0.0001) and multivariable analysis (2.3 days [95% CI: 1.8, 3.0] vs 3.3 days [2.6, 4.2], <i>P</i> < 0.0001). MLCF patients reported symptom improvement or resolution more often than UCF patients (0.43 [95% CI: 0.30, 0.62] and 0.46 [95% CI: 0.30, 0.70]). Additionally, a significantly higher rate of dysphagia was reported in the UCF group on both univariate and multivariable analysis, respectively (1.72 [95% CI: 1.18, 2.49] and 1.66 [95%CI: 1.08, 2.56]).</p><p><strong>Conclusions: </strong>To our knowledge, this is the first study to investigate the link between cervical fusion level and outcomes. UCF patients demonstrated greater rates of dysphagia, longer length of stay, and lower likelihood of improvement in neurological symptoms postoperatively both before and after controlling for differences in pre- and intraoperative characteristics.</p><p><strong>Clinical relevance: </strong>This study highlights that UCFs may be associated with worse postoperative outcomes when compared to MLCFs, which can inform surgical decision-making and patient counseling.</p><p><strong>Level of evidence: </strong>The study represents Level 3 evidence due to its retrospective design and potential biases, indicating a need for future prospective randomized controlled trials to validate these findings.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Spine Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14444/8657","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Previous research suggests a relationship between complications associated with anterior cervical discectomy and fusion and level involvement; however, there is limited research comparing postoperative outcomes of upper cervical fusions (UCFs) with middle-to-lower cervical fusions (MLCFs). This study aims to compare the outcomes of UCF with MLCF.
Methods: A retrospective medical record review was conducted on 835 anterior cervical discectomy and fusion patients from 2012 to 2022. Patients were classified as UCF, defined as inclusion of C3 to C4 disc space, or MLCF, defined as lacking C3 to C4 disc space. Demographics were compared using χ2 or Fisher exact tests. Clinical characteristics were compared in univariable analysis using χ2 tests, linear-mixed effects models, or generalized linear-mixed models depending on distribution. Significant pre- and intraoperative characteristics were included in multivariable models to minimize confounding.
Results: Of the 835 patients included, 562 underwent MLCF and 281 underwent UCF. Median follow-up time was 211 days for UCF and 200 days for MLCF. UCF led to a 1.5-day longer length of stay in both univariable (1.5 vs 3.1, P < 0.0001) and multivariable analysis (2.3 days [95% CI: 1.8, 3.0] vs 3.3 days [2.6, 4.2], P < 0.0001). MLCF patients reported symptom improvement or resolution more often than UCF patients (0.43 [95% CI: 0.30, 0.62] and 0.46 [95% CI: 0.30, 0.70]). Additionally, a significantly higher rate of dysphagia was reported in the UCF group on both univariate and multivariable analysis, respectively (1.72 [95% CI: 1.18, 2.49] and 1.66 [95%CI: 1.08, 2.56]).
Conclusions: To our knowledge, this is the first study to investigate the link between cervical fusion level and outcomes. UCF patients demonstrated greater rates of dysphagia, longer length of stay, and lower likelihood of improvement in neurological symptoms postoperatively both before and after controlling for differences in pre- and intraoperative characteristics.
Clinical relevance: This study highlights that UCFs may be associated with worse postoperative outcomes when compared to MLCFs, which can inform surgical decision-making and patient counseling.
Level of evidence: The study represents Level 3 evidence due to its retrospective design and potential biases, indicating a need for future prospective randomized controlled trials to validate these findings.
期刊介绍:
The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.