Patient Reported Outcomes After ACDF versus Laminoplasty with Foraminotomy for Cervical Spondylotic Myelopathy: A 2-Year Quality Outcomes Database Study

Friday, May 3, 2024

Presenting Author(s)

Mohamad Bydon, MD

Professor of Neurosurgery
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, Minnesota, United States

Co-Author(s)

Anthony L. Asher, MD

President AANS, Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, North Carolina, United States
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US

Submitter(s)

AC

Andrew K. Chan, MD

Assistant Professor
Columbia University
New York, New York, United States

Co-Author(s)

Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, New York, United States
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
OG

Oren N. Gottfried, MD

Professor of Neurosurgery
Duke University
Durham, North Carolina, United States
Regis William Haid, Jr., MD

Neurosurgeon
Atlanta Brain and Spine
Atlanta, Georgia, United States
Sufyan Ibrahim, MBBS

Postdoctoral Research Fellow
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, MN, US
Sarah E. Johnson, MBBS

Postdoctoral Research Fellow
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
John Knightly, MD

Director of Neurosurgery
Atlantic Neurosurgical Specialists
Morristown, New Jersey, United States
SM

Scott Meyer, MD

Neurosurgery
Altair Health
Minneapolis, Minnesota, United States
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
Paul Park, MD

Neurosurgeon
Semmes Murphey Clinic
MEMPHIS, Tennessee, United States
Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, NC, US
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, VA, US
Luis M. Tumialán, MD

Professor of Neurosurgery
Barrow Brain and Spine
Paradise Valley, Arizona, United States
Jay D. Turner, MD, PhD

Neurosurgery Faculty
Barrow Neurological Institute
Phoenix, AZ, US
Cheerag Upadhyaya, MD, MBA (he/him/his)

Vice Chair of Outpatient Operations, Chief of Business Development and Strategy, Associate Professor of Neurosurgery
University of North Carolina
Chapel Hill, North Carolina, United States
Juan S. Uribe, MD

Neurosurgeon
Barrow Neurological Insitute
Phoenix, Arizona, United States
MV

Michael S. Virk, MD, PhD

Assistant Professor
Weill Cornell Medical Center
New York, New York, United States
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US

Introduction: Symptomatic cervical spondylosis with myelopathy can be managed either by anterior decompression and fusion (ACDF) or posterior laminoplasty and foraminotomy. Due to lack of data on long-term differences in patient reported outcome measures (PROMs), we sought to compare anterior cervical discectomy and fusion (ACDF) with laminoplasty with posterior foraminotomy for spondylotic myelopathy in the cervical spine.

Methods: This was retrospective analysis on patients operated for cervical myelopathy, from the prospectively augmented dataset of the QOD Registry Cervical Module. ACDF and laminoplasty with posterior foraminotomy cases were compared at 3-month, 12-month, and 24-months. Propensity score matching was performed to adjust for the baseline differences between the two cohorts in 4:1 ratio. Minimum clinically important difference (MCID) thresholds were assessed for the following PROMs: numeric rating scale (NRS) arm pain, NRS neck pain, Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scores. North American Spine Society (NASS) satisfaction scores and Quality Adjusted Life Years (QALYs) were also assessed.

Results: 699 patients were included (655 ACDF, 44 CCF). Baseline demographics showed the ACDF cohort had a significantly lower age, baseline anxiety, proportions of independent ambulation status but greater myelopathy severity (mJOA). Laminoplasty with foraminotomy was performed at significantly more levels on average than ACDF (2.82 ± 0.83 vs 4.05 ± 0.91). Optimal matching yielded 160 patients who underwent ACDF and 40 with laminoplasty and foraminotomy. Laminoplasty with foraminotomy cohort had significantly longer length of stay (1.5 ± 1.8 vs 3.0 ± 1.6, p< 0.01). There were no significant differences regarding 30-day or 90-day readmissions or reoperations. While laminoplasty with foraminotomy patients had significantly higher rates of MCID achievement in mJOA at 3 months (79.4% vs 54.0%, p< 0.01), both groups had similar rates of MCID achievement for all PROMs, NASS satisfaction, and QALYs at all time points over 2 years.

Conclusion : Our matched analysis suggests that both ACDF and laminoplasty with foraminotomy procedures for CSM offer similar achievements of improvements in PROMs by 2-year follow-up.