Complications and in-hospital deaths more frequent among patients who undergo anterior rather than posterior spine fusion
Patients who undergo posterior
spine fusion (PSF) surgery
(approached from the person's
back) are less likely to develop
complications or die while in the
hospital than those who undergo
either anterior spine fusion
(ASF)—in which surgeons
approach the spine from the
person's front, or anterior/posterior
spine fusion (APSF)—in which the
surgeons use both approaches, a
new study finds. Even though
APSF and ASF were performed in
generally younger (44.8 and 44.2
vs. 52.1 years) and healthier
patients than PSF, the procedure-related
complications were lowest
in patients who underwent PSF
(15.7 percent) than those who
underwent ASF and APSF (18.7
percent and 23.8 percent,
respectively).
In addition, in-hospital mortality
rates after ASF and APSF were
nearly double that for PSF (0.51
percent and 0.44 percent,
respectively vs. 0.26 percent). The
researchers identified a number of
risk factors for in-hospital mortality
that need to be confirmed for use in
counseling patients about the three
types of spinal fusion. They note
that the choice of approach is often
dictated by the person's pathology
and infrequently represents an
equivalent choice.
Their findings were based on
annual data from the National
Inpatient Sample of the Hospital
Cost and Utilization Project of the
Agency for Healthcare Research
and Quality (AHRQ) for 1998
through 2006 for 261,356 patients
who underwent spine fusion
surgery not involving the neck vertebrae (noncervical spine
fusion). Information was gathered
on patient demographics,
characteristics of the hospital, and
the prevalence of comorbidities and
procedure-related complications.
The study was funded in part by
AHRQ (HS16075) to the Center for
Education and Research on
Therapeutics (CERT) at the Weill
Medical College of Cornell
University. For more information
on the CERTs program, visit
http://www.certs.hhs.gov.
More details are in "Perioperative
morbidity and mortality after
anterior, posterior, and
anterior/posterior spine fusion
surgery," by Stavros G.
Memtsoudis, M.D., Ph.D., Vassilios
I. Vougioukas, M.D., Ph.D., Yan
Ma, Ph.D., and others in the
October 2011 Spine 36(22), pp.
1867-1877.
— DIL
Return to Contents
Proceed to Next Article