Myelopathy linked with increased all-cause morbidity and mortality following ACDF


A study published ahead-of-print by the journal Spine indicates that myelopathy is associated with increased all-cause morbidity and mortality following anterior cervical discectomy and fusion (ACDF).

The authors note that “ACDF is the most common surgical procedure for the management of a spectrum of cervical spine pathologies. As a more advanced condition, myelopathy is generally believed to be associated with higher morbidity and mortality after this procedure, but there is limited evidence to support this supposition.”

Led by Adam M Lukasiewicz, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, USA, the retrospective cohort study examined a total of 5,256 ACDF patients who underwent surgery from 2010–2012. The patients were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Bivariate and multivariate logistic regressions were performed to compare 30-day adverse events and readmission between groups. Multivariate analyses controlled for patient and surgical characteristics.

Lukasiewicz et al found that myelopathic patients were older and less healthy when compared with non-myelopathic patients. Furthermore, the authors’ multivariate analusis controlling for baseline patient characteristics found that myelopathic patients were at “significantly higher risk of any adverse event (odds ratio=1.5), any severe adverse event (odds ratio=1.8), and death (odds ratio=8.9) compared to non-myelopathic patients.”

As such, the authors conclude that “not only were any adverse events and serious adverse events more common following ACDF for myelopathic patients compared to non-myelopathic patients, but mortality was approximately nine times more likely.” In closing, Lukasiewicz and colleagues suggest that such a significant difference must be kept in mind during surgical planning and patient counselling.