Laminectomy with fusion for cervical spondylotic myelopathy is associated with higher early morbidity and risk of perioperative complications compared with laminectomy alone: a retrospective study in the United States.

Study design: A retrospective cohort study.

Purpose: We present data assessing the differences in 30-day morbidity, mortality, and postoperative complications between the two surgical remedy options.

Overview of literature: The choice between decompression with fusion or decompression alone for the management of cervical spondylotic myelopathy (CSM) remains controversial.

Methods: The American College of Surgeons National Quality Improvement Program database was queried for adults ≥18 years diagnosed with spondylosis with cervical myelopathy (10th revision of the International Classification of Diseases [ICD-10]: M47.12) or spinal stenosis of the cervical region (ICD-10: M48.02) who underwent laminectomy (Current Procedural Terminology [CPT] 63001, 63015, 63045) with or without fusion (CPT 22600) between 2015 and 2020. Patients were stratified into fusion and non-fusion cohorts for comparative review. Estimated 30-day mortality and morbidity, postoperative complications, and American Society of Anesthesiologists (ASA) classification were evaluated using chi-square and analysis of variance tests, and results were further stratified according to ASA classification.

Results: Of the 6,412 patients, 3,355 (52%) received laminectomy without fusion, and 3,057 (48%) experienced laminectomy with fusion. Patients undergoing decompression with fusion had higher mean morbidity (estimated probability 0.073 vs. 0.064, p<0.001), unplanned reoperations (4.2% vs. 2.7%, p<0.002), unplanned readmissions (7.6% vs. 6.3%, p<0.014), mean length of stay (5.0±8.9 days vs. 3.4±7.2 days, p<0.001), deep wound infections (0.8% vs. 0.4%, p<0.022), and bleeding risk necessitating transfusion (3.8% vs. 1.6%, p<0.001). Stratification by ASA scores demonstrated an overall higher rate of 30-day postoperative complications with increasing ASA scores in both cohorts, However, the decompression with fusion cohort showed a greater relative increase in complications compared to the decompression-alone cohort with each ASA group.

Conclusions: Decompression with fusion is correlated with higher estimated morbidity, unplanned reoperations and readmissions, and 30-day complications postoperatively. Decompression alone is an appealing procedure option for CSM, particularly for patients with higher ASA scores and those at greater risk.