Neurosurgery 93:373–386, 2023
Although published data support the utilization of circumferential fusion to treat select cervical spine pathologies, it is unclear whether the posterior–anterior–posterior (PAP) fusion has increased risks compared with the anterior–posterior fusion.
OBJECTIVE: To evaluate the differences in perioperative complications between the 2 circumferential cervical fusion approaches.
METHODS: One hundred ﬁfty-three consecutive adult patients who underwent single-staged circumferential cervical fusion for degenerative pathologies from 2010 to 2021 were retrospectively reviewed. Patients were stratiﬁed into the anterior–posterior (n = 116) and PAP (n = 37) groups. The primary outcomes assessed were major complications, reoperation, and readmission.
RESULTS: Although the PAP group was older (P = .024), predominantly female (P = .024), with higher baseline neck disability index (P = .026), cervical sagittal vertical axis (P = .001), and previous cervical operation rate (P < .00001), the major complication, reoperation, and readmission rates were not signiﬁcantly different from the 360°group. Although the PAP group had higher urinary tract infection (P = .043) and transfusion (P = .007) rates, higher estimated blood loss (P = .034), and longer operative times (P < .00001), these differences were insigniﬁcant after the multivariable analysis. Overall, operative time was associated with older age (odds ratio [OR] 17.72, P = .042), atrial ﬁbrillation (OR 158.30, P = .045), previous cervical operation (OR 5.05, P = .051), and lower baseline C1-7 lordosis (OR 0.93, P = .007). Higher estimated blood loss was associated with older age (OR 1.13, P = .005), male gender (OR 323.31, P = .047), and higher baseline cervical sagittal vertical axis (OR 9.65, P = .022).
CONCLUSION: Despite some differences in preoperative and intraoperative variables, this study suggests both circumferential approaches have comparable reoperation, readmission, and complication proﬁles, all of which are high.