Circumferential cervical surgery: to stage or not to stage?

Area of Science:

• Neurosurgery
• Spine Surgery
• Surgical Outcomes

Background:

• Combined ventral and dorsal approaches are crucial for complex cervical spine pathologies.
• Previous research indicated benefits of same-day combined surgery in thoracolumbar spine procedures.
• This study evaluates the Physiological and Operative Severity Score for enumeration of Morbidity and Mortality (POSSUM) for risk assessment in cervical spine surgery.

Purpose of the Study:

• To compare morbidity and mortality rates between same-day and staged cervical circumferential approaches.
• To assess the utility of POSSUM in predicting outcomes for cervical spine surgery.
• To identify risk factors associated with different surgical timing strategies.

Main Methods:

• Retrospective chart review of patients undergoing ventral and dorsal cervical spine approaches within two weeks.
• Utilized POSSUM for estimated mortality risk assessment.
• Compared outcomes between same-day surgery and staged procedure groups using univariate and multivariable analyses.

Main Results:

• The study included 135 patients; 106 in the same-day group and 29 in the staged group.
• Actual mortality (3.7%) was comparable to predicted mortality by POSSUM (2.8%).
• Staged procedures showed significantly higher rates of major complications, infection, and longer hospital stays compared to same-day surgery.

Conclusions:

• POSSUM serves as a valid tool for risk stratification in cervical spine surgery.
• Staged combined cervical surgery is linked to increased complications and prolonged hospitalization.
• Same-day cervical circumferential surgery appears to be a safer and more efficient approach.