摘要

Background Context The reoperation (reop) rate is a crucial indicator of the efficacy of an operation; however, studies on the reop rates of anterior cervical discectomy and fusion (ACDF) or posterior laminoplasty (LMP) for treating multilevel cervical degenerative diseases (MCDDs) are scant. Purpose This study aimed to compare the reop rates and safety of ACDF and LMP for MCDD treatment. Study Design This is a retrospective population-based cohort study. Patient Sample Our sample consists of patients who underwent ACDF and LMP treatment. Outcome Measures Reop rate, risk of pneumonia, sepsis, surgery-related complications, and death. Methods A total of 6,605 patients who underwent ACDF and 1,578 patients who underwent LMP for MCDD treatment from 2001 to 2011 were selected from the Taiwan National Health Insurance Research Database. Cox proportional hazard models were performed to compare the clinical outcomes of the patients who underwent ACDF with those of the patients who underwent LMP. Results Long-term reop rates (per 100 person-month) were slightly Anterior cervical discectomy and fusion; in the patients who underwent ACDF (0.04 [95% confidence interval, CI: 0.03–0.05]) than in those who underwent LMP (0.06 [95% CI: 0.04–0.08]), with adjusted hazard ratio (HR) of 1.43 (95% CI: 0.96–2.11, p=.08), although short-term reop rates were significantly higher in the LMP group (0.41 [95% CI: 0.33–0.51]) than in the ACDF group (0.09 [95% CI: 0.07–0.11]), with adjusted HR of 4.81 (95% CI: 3.46–6.69, p<.001). Patients who underwent LMP had a lower risk of pneumonia, sepsis, surgery-related complications, and death than did those who underwent ACDF within a year of follow-up. The results after adjustment for all covariates showed that osteoarthritis (adjusted HR=2.07, 95% CI: 1.40–3.06, p<.01) was associated with reop risk in the patients who underwent ACDF, and diabetes (adjusted HR=3.27, 95% CI: 1.12–9.54, p=.03) was associated with reop risk in the patients who underwent LMP. Conclusions There was no significantly higher incidence rate of reop between the patients who underwent LMP and those who underwent ACDF after 1-year follow-up; however, ACDF was associated with a higher rate of 1-year complications and mortality compared with LMP. LMP might be considered as a treatment option for MCDD but could not be appropriate for patients with cervical kyphotic deformity.
原文英語
頁(從 - 到)1428-1436
頁數9
期刊Spine Journal
16
發行號12
DOIs
出版狀態已發佈 - 十二月 1 2016

指紋

Diskectomy
Taiwan
Reoperation
Cohort Studies
Population
Laminoplasty
Sepsis
Pneumonia
National Health Programs
Therapeutics
Proportional Hazards Models
Osteoarthritis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

引用此文

@article{c84a308496f14519955fa7e8a3c49e1c,
title = "Reoperation rates of anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical degenerative diseases: a population-based cohort study in Taiwan",
abstract = "Background Context The reoperation (reop) rate is a crucial indicator of the efficacy of an operation; however, studies on the reop rates of anterior cervical discectomy and fusion (ACDF) or posterior laminoplasty (LMP) for treating multilevel cervical degenerative diseases (MCDDs) are scant. Purpose This study aimed to compare the reop rates and safety of ACDF and LMP for MCDD treatment. Study Design This is a retrospective population-based cohort study. Patient Sample Our sample consists of patients who underwent ACDF and LMP treatment. Outcome Measures Reop rate, risk of pneumonia, sepsis, surgery-related complications, and death. Methods A total of 6,605 patients who underwent ACDF and 1,578 patients who underwent LMP for MCDD treatment from 2001 to 2011 were selected from the Taiwan National Health Insurance Research Database. Cox proportional hazard models were performed to compare the clinical outcomes of the patients who underwent ACDF with those of the patients who underwent LMP. Results Long-term reop rates (per 100 person-month) were slightly Anterior cervical discectomy and fusion; in the patients who underwent ACDF (0.04 [95{\%} confidence interval, CI: 0.03–0.05]) than in those who underwent LMP (0.06 [95{\%} CI: 0.04–0.08]), with adjusted hazard ratio (HR) of 1.43 (95{\%} CI: 0.96–2.11, p=.08), although short-term reop rates were significantly higher in the LMP group (0.41 [95{\%} CI: 0.33–0.51]) than in the ACDF group (0.09 [95{\%} CI: 0.07–0.11]), with adjusted HR of 4.81 (95{\%} CI: 3.46–6.69, p<.001). Patients who underwent LMP had a lower risk of pneumonia, sepsis, surgery-related complications, and death than did those who underwent ACDF within a year of follow-up. The results after adjustment for all covariates showed that osteoarthritis (adjusted HR=2.07, 95{\%} CI: 1.40–3.06, p<.01) was associated with reop risk in the patients who underwent ACDF, and diabetes (adjusted HR=3.27, 95{\%} CI: 1.12–9.54, p=.03) was associated with reop risk in the patients who underwent LMP. Conclusions There was no significantly higher incidence rate of reop between the patients who underwent LMP and those who underwent ACDF after 1-year follow-up; however, ACDF was associated with a higher rate of 1-year complications and mortality compared with LMP. LMP might be considered as a treatment option for MCDD but could not be appropriate for patients with cervical kyphotic deformity.",
keywords = "Anterior cervical discectomy and fusion, Cervical spondylotic myelopathy, Complication, Laminoplasty, Multilevel cervical degenerative diseases, Reoperation",
author = "Lin, {Jiann Her} and Chien, {Li Nien} and Tsai, {Wan Ling} and Chen, {Li Ying} and Hsieh, {Yi Chen} and Chiang, {Yung Hsiao}",
year = "2016",
month = "12",
day = "1",
doi = "10.1016/j.spinee.2016.08.017",
language = "English",
volume = "16",
pages = "1428--1436",
journal = "Spine Journal",
issn = "1529-9430",
publisher = "Elsevier Inc.",
number = "12",

}

TY - JOUR

T1 - Reoperation rates of anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical degenerative diseases

T2 - a population-based cohort study in Taiwan

AU - Lin, Jiann Her

AU - Chien, Li Nien

AU - Tsai, Wan Ling

AU - Chen, Li Ying

AU - Hsieh, Yi Chen

AU - Chiang, Yung Hsiao

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background Context The reoperation (reop) rate is a crucial indicator of the efficacy of an operation; however, studies on the reop rates of anterior cervical discectomy and fusion (ACDF) or posterior laminoplasty (LMP) for treating multilevel cervical degenerative diseases (MCDDs) are scant. Purpose This study aimed to compare the reop rates and safety of ACDF and LMP for MCDD treatment. Study Design This is a retrospective population-based cohort study. Patient Sample Our sample consists of patients who underwent ACDF and LMP treatment. Outcome Measures Reop rate, risk of pneumonia, sepsis, surgery-related complications, and death. Methods A total of 6,605 patients who underwent ACDF and 1,578 patients who underwent LMP for MCDD treatment from 2001 to 2011 were selected from the Taiwan National Health Insurance Research Database. Cox proportional hazard models were performed to compare the clinical outcomes of the patients who underwent ACDF with those of the patients who underwent LMP. Results Long-term reop rates (per 100 person-month) were slightly Anterior cervical discectomy and fusion; in the patients who underwent ACDF (0.04 [95% confidence interval, CI: 0.03–0.05]) than in those who underwent LMP (0.06 [95% CI: 0.04–0.08]), with adjusted hazard ratio (HR) of 1.43 (95% CI: 0.96–2.11, p=.08), although short-term reop rates were significantly higher in the LMP group (0.41 [95% CI: 0.33–0.51]) than in the ACDF group (0.09 [95% CI: 0.07–0.11]), with adjusted HR of 4.81 (95% CI: 3.46–6.69, p<.001). Patients who underwent LMP had a lower risk of pneumonia, sepsis, surgery-related complications, and death than did those who underwent ACDF within a year of follow-up. The results after adjustment for all covariates showed that osteoarthritis (adjusted HR=2.07, 95% CI: 1.40–3.06, p<.01) was associated with reop risk in the patients who underwent ACDF, and diabetes (adjusted HR=3.27, 95% CI: 1.12–9.54, p=.03) was associated with reop risk in the patients who underwent LMP. Conclusions There was no significantly higher incidence rate of reop between the patients who underwent LMP and those who underwent ACDF after 1-year follow-up; however, ACDF was associated with a higher rate of 1-year complications and mortality compared with LMP. LMP might be considered as a treatment option for MCDD but could not be appropriate for patients with cervical kyphotic deformity.

AB - Background Context The reoperation (reop) rate is a crucial indicator of the efficacy of an operation; however, studies on the reop rates of anterior cervical discectomy and fusion (ACDF) or posterior laminoplasty (LMP) for treating multilevel cervical degenerative diseases (MCDDs) are scant. Purpose This study aimed to compare the reop rates and safety of ACDF and LMP for MCDD treatment. Study Design This is a retrospective population-based cohort study. Patient Sample Our sample consists of patients who underwent ACDF and LMP treatment. Outcome Measures Reop rate, risk of pneumonia, sepsis, surgery-related complications, and death. Methods A total of 6,605 patients who underwent ACDF and 1,578 patients who underwent LMP for MCDD treatment from 2001 to 2011 were selected from the Taiwan National Health Insurance Research Database. Cox proportional hazard models were performed to compare the clinical outcomes of the patients who underwent ACDF with those of the patients who underwent LMP. Results Long-term reop rates (per 100 person-month) were slightly Anterior cervical discectomy and fusion; in the patients who underwent ACDF (0.04 [95% confidence interval, CI: 0.03–0.05]) than in those who underwent LMP (0.06 [95% CI: 0.04–0.08]), with adjusted hazard ratio (HR) of 1.43 (95% CI: 0.96–2.11, p=.08), although short-term reop rates were significantly higher in the LMP group (0.41 [95% CI: 0.33–0.51]) than in the ACDF group (0.09 [95% CI: 0.07–0.11]), with adjusted HR of 4.81 (95% CI: 3.46–6.69, p<.001). Patients who underwent LMP had a lower risk of pneumonia, sepsis, surgery-related complications, and death than did those who underwent ACDF within a year of follow-up. The results after adjustment for all covariates showed that osteoarthritis (adjusted HR=2.07, 95% CI: 1.40–3.06, p<.01) was associated with reop risk in the patients who underwent ACDF, and diabetes (adjusted HR=3.27, 95% CI: 1.12–9.54, p=.03) was associated with reop risk in the patients who underwent LMP. Conclusions There was no significantly higher incidence rate of reop between the patients who underwent LMP and those who underwent ACDF after 1-year follow-up; however, ACDF was associated with a higher rate of 1-year complications and mortality compared with LMP. LMP might be considered as a treatment option for MCDD but could not be appropriate for patients with cervical kyphotic deformity.

KW - Anterior cervical discectomy and fusion

KW - Cervical spondylotic myelopathy

KW - Complication

KW - Laminoplasty

KW - Multilevel cervical degenerative diseases

KW - Reoperation

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U2 - 10.1016/j.spinee.2016.08.017

DO - 10.1016/j.spinee.2016.08.017

M3 - Article

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SP - 1428

EP - 1436

JO - Spine Journal

JF - Spine Journal

SN - 1529-9430

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