Cargando…
Comparing Combined Anterior and Posterior to Posterior-Only Decompression and Fusion Crossing the Cervico-Thoracic Junction in Octogenarians
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of the study was to compare early complication, morbidity and mortality risks associated with fusion surgery crossing the cervico-thoracic junction in patients aged over 80 years undergoing combined anterior and posterior approach vers...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837525/ https://www.ncbi.nlm.nih.gov/pubmed/33715487 http://dx.doi.org/10.1177/2192568221994793 |
_version_ | 1784869099288920064 |
---|---|
author | Ishak, Basem Abdul-Jabbar, Amir von Glinski, Alexander Yilmaz, Emre Unterberg, Andreas W. Hopkins, Sarah Roh, Jeffrey Oskouian, Rod Hart, Robert Chapman, Jens R. |
author_facet | Ishak, Basem Abdul-Jabbar, Amir von Glinski, Alexander Yilmaz, Emre Unterberg, Andreas W. Hopkins, Sarah Roh, Jeffrey Oskouian, Rod Hart, Robert Chapman, Jens R. |
author_sort | Ishak, Basem |
collection | PubMed |
description | STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of the study was to compare early complication, morbidity and mortality risks associated with fusion surgery crossing the cervico-thoracic junction in patients aged over 80 years undergoing combined anterior and posterior approach versus a posterior-only approach. METHODS: We retrospectively identified octogenarian patients with myelopathy who underwent fusion crossing the cervico-thoracic junction. Patient demographics, Nurick score, surgical characteristics, complications, hospital course, early outcome and 90-day mortality were collected. Comorbidities were classified using the age-adjusted Charlson Comorbidity Index (AACCI). Radiographic measurements for deformity correction included the C2-C7 sagittal Cobb angle, C2-7 sagittal vertical axis and T1 slope pre- and postoperatively. RESULTS: Out of 8,521 surgically treated patients, 12 octogenarian patients had a combined anterior and posterior approach (AP group) and 14 were treated from posterior-only (P group). Mean age was 81.4 ± 1.2 and 82.5 ± 2.7 years, respectively. There was no significant difference in Nurick scores between the groups (P > 0.05). The major complication risk in the AP group was significantly higher, requiring PEG tube placement due to severe dysphagia in 4 patients (33%) compared to none in the P group. A greater improvement in cervical lordosis could be achieved through a combined approach. The 90-day mortality risk was 8% for the AP group and 0% for the P group. CONCLUSIONS: A combined anterior and posterior approach is associated with a significantly higher major complication rate and can result in severe dysphagia requiring PEG tube placement in one-third of patients over 80 years of age. |
format | Online Article Text |
id | pubmed-9837525 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-98375252023-01-14 Comparing Combined Anterior and Posterior to Posterior-Only Decompression and Fusion Crossing the Cervico-Thoracic Junction in Octogenarians Ishak, Basem Abdul-Jabbar, Amir von Glinski, Alexander Yilmaz, Emre Unterberg, Andreas W. Hopkins, Sarah Roh, Jeffrey Oskouian, Rod Hart, Robert Chapman, Jens R. Global Spine J Original Articles STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of the study was to compare early complication, morbidity and mortality risks associated with fusion surgery crossing the cervico-thoracic junction in patients aged over 80 years undergoing combined anterior and posterior approach versus a posterior-only approach. METHODS: We retrospectively identified octogenarian patients with myelopathy who underwent fusion crossing the cervico-thoracic junction. Patient demographics, Nurick score, surgical characteristics, complications, hospital course, early outcome and 90-day mortality were collected. Comorbidities were classified using the age-adjusted Charlson Comorbidity Index (AACCI). Radiographic measurements for deformity correction included the C2-C7 sagittal Cobb angle, C2-7 sagittal vertical axis and T1 slope pre- and postoperatively. RESULTS: Out of 8,521 surgically treated patients, 12 octogenarian patients had a combined anterior and posterior approach (AP group) and 14 were treated from posterior-only (P group). Mean age was 81.4 ± 1.2 and 82.5 ± 2.7 years, respectively. There was no significant difference in Nurick scores between the groups (P > 0.05). The major complication risk in the AP group was significantly higher, requiring PEG tube placement due to severe dysphagia in 4 patients (33%) compared to none in the P group. A greater improvement in cervical lordosis could be achieved through a combined approach. The 90-day mortality risk was 8% for the AP group and 0% for the P group. CONCLUSIONS: A combined anterior and posterior approach is associated with a significantly higher major complication rate and can result in severe dysphagia requiring PEG tube placement in one-third of patients over 80 years of age. SAGE Publications 2021-03-10 2023-01 /pmc/articles/PMC9837525/ /pubmed/33715487 http://dx.doi.org/10.1177/2192568221994793 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Articles Ishak, Basem Abdul-Jabbar, Amir von Glinski, Alexander Yilmaz, Emre Unterberg, Andreas W. Hopkins, Sarah Roh, Jeffrey Oskouian, Rod Hart, Robert Chapman, Jens R. Comparing Combined Anterior and Posterior to Posterior-Only Decompression and Fusion Crossing the Cervico-Thoracic Junction in Octogenarians |
title | Comparing Combined Anterior and Posterior to Posterior-Only
Decompression and Fusion Crossing the Cervico-Thoracic Junction in
Octogenarians |
title_full | Comparing Combined Anterior and Posterior to Posterior-Only
Decompression and Fusion Crossing the Cervico-Thoracic Junction in
Octogenarians |
title_fullStr | Comparing Combined Anterior and Posterior to Posterior-Only
Decompression and Fusion Crossing the Cervico-Thoracic Junction in
Octogenarians |
title_full_unstemmed | Comparing Combined Anterior and Posterior to Posterior-Only
Decompression and Fusion Crossing the Cervico-Thoracic Junction in
Octogenarians |
title_short | Comparing Combined Anterior and Posterior to Posterior-Only
Decompression and Fusion Crossing the Cervico-Thoracic Junction in
Octogenarians |
title_sort | comparing combined anterior and posterior to posterior-only
decompression and fusion crossing the cervico-thoracic junction in
octogenarians |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837525/ https://www.ncbi.nlm.nih.gov/pubmed/33715487 http://dx.doi.org/10.1177/2192568221994793 |
work_keys_str_mv | AT ishakbasem comparingcombinedanteriorandposteriortoposterioronlydecompressionandfusioncrossingthecervicothoracicjunctioninoctogenarians AT abduljabbaramir comparingcombinedanteriorandposteriortoposterioronlydecompressionandfusioncrossingthecervicothoracicjunctioninoctogenarians AT vonglinskialexander comparingcombinedanteriorandposteriortoposterioronlydecompressionandfusioncrossingthecervicothoracicjunctioninoctogenarians AT yilmazemre comparingcombinedanteriorandposteriortoposterioronlydecompressionandfusioncrossingthecervicothoracicjunctioninoctogenarians AT unterbergandreasw comparingcombinedanteriorandposteriortoposterioronlydecompressionandfusioncrossingthecervicothoracicjunctioninoctogenarians AT hopkinssarah comparingcombinedanteriorandposteriortoposterioronlydecompressionandfusioncrossingthecervicothoracicjunctioninoctogenarians AT rohjeffrey comparingcombinedanteriorandposteriortoposterioronlydecompressionandfusioncrossingthecervicothoracicjunctioninoctogenarians AT oskouianrod comparingcombinedanteriorandposteriortoposterioronlydecompressionandfusioncrossingthecervicothoracicjunctioninoctogenarians AT hartrobert comparingcombinedanteriorandposteriortoposterioronlydecompressionandfusioncrossingthecervicothoracicjunctioninoctogenarians AT chapmanjensr comparingcombinedanteriorandposteriortoposterioronlydecompressionandfusioncrossingthecervicothoracicjunctioninoctogenarians |