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Tables
- Table 1
Baseline demographics and hospital presentation amongst the four surgical approaches. All cohorts were statistically different from one another in every possible combination (p<0.0001), except the difference between the laminoplasty and combined cohorts for Deyo score was not statistically significant (p>0.05).
Anterior Posterior Decompression Only Decompression with Posterior Fusion Combined AP P-value Age 57.5 63.4 63.0 59.6 <0.0001 LOS 2.8 4.7 5.8 7.5 <0.0001 Deyo Score 0.50 0.65 0.71 0.66 <0.0001 - Table 2
Baseline comorbidities amongst the four surgical approaches. The cohort with the largest percentage of complications is shaded.
Comorbidity Percentage of Anterior Percentage of Posterior Decompression Only Laminoplasty Percentage of Laminectom Decompression with Posterior Fusion Percentage of Combined AP p-value Anemia 3.01 4.96 6.88 10.70 <0.0001 Rheumatoid arthritis/collagen vascular diseases 2.60 2.67 5.54 5.93 <0.0001 Chronic blood loss anemia 0.13 0.34 0.40 0.88 <0.0001 Congestive heart failure 1.97 3.48 3.78 3.27 <0.0001 Chronic pulmonary disease 15.65 16.50 17.90 18.31 <0.0001 Coagulopathy 0.69 1.22 1.51 1.86 <0.0001 Diabetes 16.94 20.63 21.61 18.53 <0.0001 Hypertension 46.94 54.71 57.83 54.27 <0.0001 Liver disease 0.50 0.79 0.86 0.75 <0.0001 Electrolyte imbalance 3.13 6.35 9.08 14.60 <0.0001 Neurological disorder 3.70 4.97 5.21 5.48 <0.0001 Obesity 7.42 6.79 6.97 7.21 <0.0001 Peripheral vascular disorders 1.73 2.62 2.84 2.17 <0.0001 Pulmonary circulation disorders 0.35 0.55 1.00 0.97 <0.0001 Renal failure 1.76 3.11 3.59 3.89 <0.0001 Cardiac valvular disorder 2.45 3.01 3.25 2.96 <0.0001 Pathologic weight loss 0.54 0.81 1.30 2.30 <0.0001 Anterior Posterior Decompression Only Decompression with Posterior Fusion Combined AP P-value 6.3% 8.9% 14.7% 27.9% <0.0001 - Table 4
Multivariate analysis of morbidity using the anterior cohort as the referent value adjusted for age, race, gender, Deyo score, and obesity.
Morbidity Odds Ratio Lower CI Upper CI p-value Anterior - - - - Posterior Decompression Only 1.30 1.24 1.36 <0.0001 Decompression with Posterior Fusion 2.19 2.11 2.28 <0.0001 Combined AP 5.44 5.16 5.74 <0.0001 - Table 5
Complications amongst the four surgical approaches. The cohort with the largest percentage of complications is shaded.
Complication Percentage of Anterior Percentage of Posterior Decompression Only Percentage of Decompression with Posterior Fusion Percentage of Combined AP p Value Device-related 0.90 0.27 2.57 6.81 <0.0001 Nervous System 0.45 0.82 0.90 1.46 <0.0001 Cardiac 0.56 0.92 1.28 1.50 <0.0001 Peripheral Vascular 0.03 0.10 0.06 0.09 <0.0001 Respiratory 0.60 0.90 1.06 2.03 <0.0001 Digestive System 0.30 0.36 0.41 0.62 <0.0001 Urinary 0.56 1.41 1.40 1.02 <0.0001 Post-op Shock 0.03 0.04 0.10 0.18 <0.0001 Hematoma/ Seroma 0.81 0.65 1.25 1.72 <0.0001 Puncture Vessel/ Nerve 0.56 0.92 0.92 1.59 <0.0001 Wound Dehiscence 0.02 0.14 0.23 0.31 <0.0001 Postoperative Infection 0.09 0.47 0.54 0.71 <0.0001 Acute Post hemorrhagic Ane-mia 1.05 1.87 4.24 8.23 <0.0001 Adult Respiratory Distress Syndrome 1.21 1.02 2.00 9.42 <0.0001 Venous Thrombotic Events 0.28 0.42 0.80 0.84 <0.0001 - Table 6
Comparing mortality rate among the surgical approach groups. *All cohorts were statistically different from one another in every possible combination (p<0.0001), except the difference between the anterior techniques and laminoplasty cohorts was not statistically significant (p>0.05).
Anterior Posterior Decompression Only Decompression with Posterior Fusion Combined AP P-value 0.33% 0.43% 0.64% 1.06% <0.0001 - Table 7
Multivariate analysis of mortality using the anterior cohort as the referent value adjusted for age, race, gender, Deyo score, and obesity.
Mortality Odds Ratio Lower CI Upper CI P-value Anterior - - - - Posterior Decompression Only 0.88 0.74 1.06 0.186 Decompression with Posterior Fusion 1.22 1.04 1.44 0.017 Combined AP 2.74 2.18 3.44 <0.0001 Category Limitation Disease Severity Cannot indicate severity of pre-operative CSM
Cannot identify or weigh differently the variation in neurologic function
Nurick, Frankel, JOA, or Ducker Motor Index quantitative assessment of neurologic involvement unavailable
Presence or absence of myelomalacia is not controlled for
Surgical Approach Laminoplasty versus laminectomy differentiation using ICD-9-CM codes is difficult
NIS database does not list the presence nor the type of spinal instrumentation
NIS database pools together one-level surgeries with multi-level, including 5-level, operations.
The number of surgical vertebral levels has an impact on outcomes and it is expected that the combined anterior-posterior group has the highest number of multilevel cases.
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