The retrospective analysis examined a consecutive series of 1,358 patients who underwent cervical spine surgery performed by a single surgeon. The procedural breakdown included:

• 1,038 anterior approaches
• 29 posterior approaches
• 28 combined anterior and posterior approaches

There were 214 posterior decompression patients, 14 laminoplasty patients and 69 foraminotomy patients. There were 32 patients who had arthroplasty and 17 patients who underwent a combination of arthroplasty and anterior arthrodesis.

Here are the findings:

1. There was a relatively constant adjacent segment reoperation rate of 2.3 percent of patients per year.

2. A Kaplan-Meier analysis predicts 21.9 percent of the patients will need an adjacent segment surgery 10 years postoperatively.

3. Factors associated with increased reoperation risk at the adjacent segment include:

• Smoking
• Female sex
• Type of surgery

4. Posterior-only arthrodesis or combined anterior and posterior arthrodesis had a 7.5-times greater risk of the adjacent-segment disease requiring surgery than posterior decompression, and three-times greater risk than anterior arthrodesis, according to the report.

5. The arthroplasty group — including arthroplasty alone and hybrid arthroplasty, anterior cervical arthrodesis group and posterior decompression group showed no significant differences in reoperation risk.

6. The other factors that didn’t show risk were:

• Age
• Neurological diagnosis
• Diabetes
• Number of surgically treated segments

Source

The researchers analyzed data from the American College of Surgeons National Surgical Quality Improvement Project Database. There were 50,361 patients included in the study. Neurosurgeons performed surgery on 66 percent; the remaining were treated by an orthopedic surgeon.

Here are five key findings from the study:

1. The only differences between the surgical subspecialties were diagnosis and outcomes.

2. When orthopedic surgeons performed the elective spine surgeries, patients were twice as likely to have a prolonged hospital length of stay as when neurosurgeons were performing the procedure. Even after matching patients on propensity scores, patients treated by orthopedic surgeons had slightly higher odds of longer length of stay.

3. Patients who underwent treatment by orthopedic surgeons were also more likely to:

• Receive a perioperative transfusion
• Have complications
• Require discharge with continued care

After matching patients, those treated by orthopedic surgeons were at twice the odds for receiving perioperative transfusions when compared with the neurosurgeons’ patients.

4. The difference in length of stay remained even when taking perioperative transfusions into account.

5. However, differences in 30-day postoperative outcomes were minimal. “Analysis of a large, multi-institutional sample of prospectively collected clinical data suggests that surgeon specialty has limited influence on short-term outcomes after elective spine surgery,” concluded the study authors.