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.