Cervical Spine Surgery: Approach-Related Complications

Cervical spine surgery is a common procedure for treatment of wide variety of pathologies. In this paper we report approach-related complication rates experienced by our patients.

We retrospectively evaluated data from patients who were treated surgically for cervical pathologies from February 2011 to October 2013. Medical records were collected and evaluated. We compared the anterior cervical approach with the posterior cervical approach for patients operated for all cervical pathologies, and a subanalysis was performed for patients with cervical myelopathy.

The study included 251 patients (192 anterior vs. 59 posterior). The anterior approach patients were younger (not significant), but the indications for surgery varied significantly. Mean number of levels treated was 2.2 and 3.5 for anterior and posterior approaches, respectively (statistically significant). Neurologic status change was favorable for both surgical approaches. Total and deep wound infection rates (5.8% vs. 11.9%; P = 0.008; 0.5% vs. 8.5%; P < 0.0005) were significantly greater for the posterior approach As well as total complication rate (7.8% vs. 20.3%; P = 0.005). A subanalysis that included only cervical myelopathy patients (131 anterior vs. 33 posterior) demonstrated again greater levels of deep wound infections and total infection rates for posterior approach (0% vs. 12%; P < 0.0005; 12% vs. 1.5%; P < 0.005). Total complication rate in the myelopathy group was greater for the posterior approach (6.1% vs. 18.1%; P = 0.026).

Both the posterior and the anterior approaches are highly efficacious in preventing neurologic deterioration and in most cases improve neurological function. This study demonstrates that the anterior approach was associated with significantly lower rates of complication especially infection related complications.