Clinical Orthopaedics and Related Research®

, Volume 469, Issue 3, pp 649–657

Increased In-hospital Complications After Primary Posterior versus Primary Anterior Cervical Fusion

  • Stavros G. Memtsoudis
  • Alexander Hughes
  • Yan Ma
  • Ya Lin Chiu
  • Andrew A. Sama
  • Federico P. Girardi
Symposium: Current Concepts in Cervical Spine Surgery



Although anterior (ACDF) and posterior cervical fusion (PCDF) are relatively common procedures and both are associated with certain complications, the relative frequency and severity of these complications is unclear. Since for some patients either approach might be reasonable it is important to know the relative perioperative risks for decision-making.


The purposes of this study were to: (1) characterize the patient population undergoing ACDF and PCDF; (2) compare perioperative complication rates; (3) determine independent risk factors for adverse perioperative events; and (4) aid in surgical decision-making in cases in which clinical equipoise exists between anterior and posterior cervical fusion procedures.


The National Inpatient Sample was used and entries for ACDF and PCDF between 1998 and 2006 were analyzed. Demographics and complication rates were determined and regression analysis was performed to identify independent risk factors for mortality after ACDF and PCDF.


ACDF had a shorter length of stay and their procedures were more frequently performed at nonteaching institutions. The incidence of complications and mortality was 4.14% and 0.26% among patients undergoing ACDF and 15.35% and 1.44% for patients undergoing PCDF, respectively. When controlling for overall comorbidity burden and other demographic variables, PCDF was associated with a twofold increased risk of a fatal outcome compared with ACDF. Pulmonary, circulatory, and renal disease were associated with the highest odds for in-hospital mortality.


PCDF procedures were associated with higher perioperative rates of complications and mortality compared with ACDF surgeries. Despite limitations, these data should be considered in cases in which clinical equipoise exists between both approaches.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.


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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Stavros G. Memtsoudis
    • 1
  • Alexander Hughes
    • 3
  • Yan Ma
    • 2
  • Ya Lin Chiu
    • 2
  • Andrew A. Sama
    • 3
  • Federico P. Girardi
    • 3
  1. 1.Department of Anesthesiology, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA
  2. 2.Department of Public Health and Biostatistics, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA
  3. 3.Department of Orthopaedic Surgery, Division of Spine Surgery, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA

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