Degenerative cervical myelopathy in HIV: Rates of postoperative complications and revision following decompression surgery

Abstract

Background

HIV has been associated with cervical myelopathy, but it is unclear if HIV leads to earlier presentation of DCM and need for decompression surgery. Furthermore, long-term rates of postoperative complications and revision following decompression surgery have not been investigated in this patient population. The aim of this study was to identify the age of surgery for degenerative cervical myelopathy (DCM) in patients with human immunodeficiency virus (HIV) and investigate postoperative revision and complication rates.

Methods

Patients who underwent decompression surgery for DCM were identified in a national database and stratified by preexisting diagnosis of HIV. Demographic characteristics were identified. The 2-year rates of revision surgery, 2-year rates of postoperative surgical complications, and 90-day rates of postoperative medical complications were calculated.

Results

1,014 patients with HIV and 153,974 patients without HIV were identified. The HIV group was younger at the time of decompression (53.6 ± 8.8; Non-HIV: 57.1 ± 11.0; p<.0001). There were no statistically significant differences in 2-year rates of revision (HIV: 7.6 %; Non-HIV 7.72 %; p=.88), removal of implants (HIV: 0.99 %; Non-HIV 1.06 %; p=.82), or I&D (HIV: 1.78 %; Non-HIV 1.31 %; p=.19). There were significant differences in the 2-year rates of infection diagnosis (HIV 4.93 %, non-HIV 3.59 %; p=.022) and neurological deficit (HIV 6.02 %, non-HIV 4.20 %; p<.001). 90-day medical complications of pneumonia, UTI, and renal failure were higher in the HIV group.

Conclusions

Patients with HIV who develop cervical myelopathy undergo decompression at a younger age; this age difference may not be clinically significant. While patients with HIV are more likely to have higher rates of short-term medical complications, they do not experience higher 2-year rates of revision or surgical complications requiring reoperation.