Myelopathy is associated with increased all-cause morbidity and mortality following ACDF


Myelopathy is associated with increased morbidity and mortality after anterior cervical discectomy and fusion (ACDF) compared with other indications for this procedure, according to a new study published ahead-of-print by Spine.

Adam M Lukasiewicz, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, USA, the study authors write, “As a more advanced condition, myelopathy is generally thought to be associated with higher morbidity and mortality” following an ACDF procedure, though there is “limited evidence” to support such a suggestion. As “the most common surgical procedure” for the management of a wide range of cervical spine pathologies, the authors intended to evaluate any association between ACDF and an increased morbidity and mortality as a result of myelopathy.

The retrospective cohort study compares outcomes of ACDF procedures performed for myelopathy with those performed for other indications, controlling for other patient factors.

The authors used the American College of Surgeons National Surgical Quality Improvement Program database to identify a total of 5,256 ACDF procedures carried out between 2010 and 2012, of which 1,425 (27.3%) were performed for cervical myelopathy.

The authors report that patients with myelopathy were older and were less healthy than patients without myelopathy. Multivariate analysis controlling for baseline patient characteristics found that patients with myelopathy were at significantly increased risk of any adverse event (odds ratio=1.5), any severe adverse event (odds ratio=1.8), and death (odds ratio=8.9) compared with patients without myelopathy.

After adjusting for baseline patient characteristics, “not only were any adverse events and serious adverse events more common after ACDF for patients with myelopathy than for patients without myelopathy, but mortality was approximately nine times more likely” write the authors. Lukasiewicz and colleagues thus advise that “surgical planning and patient counselling keep this significant difference in mind for this common procedure that has different morbidities based on the pathology for which it is performed.”