Perioperative complications of anterior decompression with fusion versus laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament: Propensity score matching analysis using a nation-wide inpatient database

Publication date: Available online 26 October 2018

Source: The Spine Journal

Author(s): Shingo Morishita, Toshitaka Yoshii, Atsushi Okawa, Kiyohide Fushimi, Takeo Fujiwara

Abstract

Background Context

Surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications.

Purpose

To compare the perioperative complications post-ADF and LAMP for cervical OPLL using a large national inpatient database.

Study design

A retrospective cohort study with propensity score matching analysis.

Patient sample

Overall, 8718 (ADF/LAMP:1333/7485) patients who underwent surgery for cervical OPLL from April 1, 2010 to March 31, 2016 in hospitals using the Diagnosis Procedure Combination (DPC) were analyzed.

Outcome measures

The occurrence of postoperative complications during hospitalization.

Methods

We compared the perioperative systemic and local complications, reoperation rates and costs between ADF and LAMP using propensity score matching analysis.

Results

One-to-one matching resulted in 1192 pairs of patients who underwent ADF and LAMP. The postoperative cardiovascular event rate was significantly higher (ADF/LAMP=1.9/0.8%, P=0.013) in the ADF group. The incidence rates of dysphagia (similarly, 2.4/0.2%, P<0.001), pneumonia (1.0/0.3%, P=0.045) and spinal fluid leakage (2.4/0.4%, P<0.001) were also higher in the ADF group, even after matching. The costs were also higher in the ADF group. However, surgical site infection (2.0/3.4%, P=0.033) was significantly lower in the ADF group. No significant difference in the reoperation rates was found between the groups.

Conclusion

The present study, using a large nationwide database, demonstrated that perioperative complications were more common in the ADF group, but that SSI was more frequently observed in the LAMP group.

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