A Comparative Analysis of Patients Undergoing Fusion for Adult Cervical Deformity by Approach Type

Study Design: Retrospective cohort study.

Objective: To provide insight into postoperative complications, short-term quality outcomes, and costs of the surgical approaches of adult cervical deformity (ACD).

Methods: A national database was queried from 2007 to 2016 to identify patients who underwent cervical fusion for ACD. Patients were stratified by approach type-anterior, posterior, or circumferential. Patients undergoing anterior and posterior approach surgeries were additionally compared using propensity score matching.

Results: A total of 6575 patients underwent multilevel cervical fusion for ACD correction. Circumferential fusion had the highest postoperative complication rate (46.9% vs posterior: 36.7% vs anterior: 18.5%, < .0001). Anterior fusion patients more commonly required reoperation compared with posterior fusion patients ( < .0001), and 90-day readmission rate was highest for patients undergoing circumferential fusion ( < .0001). After propensity score matching, the complication rate remained higher in the posterior, as compared to the anterior fusion group ( < .0001). Readmission rate also remained higher in the posterior fusion group; however, anterior fusion patients were more likely to require reoperation. At index hospitalization, posterior fusion led to 1.5× higher costs, and total payments at 90 days were 1.6× higher than their anterior fusion counterparts.

Conclusion: Patients who undergo posterior fusion for ACD have higher complication rates, readmission rates, and higher cost burden than patients who undergo anterior fusion; however, posterior correction of ACD is associated with a lower rate of reoperation.