Which Spinal Fusion Approach Provides a Lower Risk of Post-Surgical Complications For Elderly Patients With Cervical Trauma?

A propensity score-matched comparison of anterior vs posterior approaches for managing cervical trauma in elderly patients (older than 65 years of age) found that the posterior approach can potentially offer a lower risk of short-term complications.

“Cervical spine injuries often lead to long-term disability, causing significant motor and sensory deficits and chronic pain,” the authors wrote. “Prompt surgical intervention is vital to prevent further neurological deterioration and instability, especially in elderly patients who tend to have higher complication rates due to comorbidities and extended recovery periods.”

For their study, researchers queried the National Trauma Data Bank for all patients older than 65 years of age with cervical trauma who underwent subsequent spinal fusion surgery with anterior or posterior approaches from 2017 to 2019. They investigated in-hospital complications following anterior and posterior spinal fusion surgeries in these patients.

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Researchers identified a total of 10,593 patients who met the inclusion criteria, with 1675 patients undergoing fusion with an anterior approach and 1317 patients with a posterior approach. Patients receiving combined management were excluded.

To compare patient demographics, in-hospital complications, and length of stay between the two approaches, researchers performed Student t-tests and Chi-squared tests.

Researchers found that most patients had sustained minor injuries in both groups. Patients in the posterior approach group had a higher proportion of White, female patients, and those with private insurance. They also had a higher total Glasgow Coma Scale (GCS) score (p < 0.05). After matching, they had a lower risk of developing deep vein thrombosis, experiencing cardiac arrest, and requiring intubation (p < 0.05).

“To our knowledge, this study represents the largest investigation into disparities in in-hospital complications between surgical approaches for cervical trauma in elderly patients,” the authors concluded. “Our findings suggest that the posterior approach may offer a lower risk of short-term complications, underscoring its clinical advantages. Further research is warranted to uncover the long-term implications of these surgical choices.”

Reference
Bhaskara M, Chauhry NS, Jiang SH, Mehta A, Sadeh M. Management of cervical trauma in elderly patients: a propensity score-matched comparison of anterior vs. posterior approaches. Abstract presented at: American Association of Neurological Surgeons 2024 Scientific Meeting; May 3-6, 2024; Chicago, IL. Accessed April 23, 2024. https://annualmeeting.aans.org/.