• Yaroslav Gelfand, Joshua A Benton, Michael Longo, Rafael de la Garza Ramos, Naomi Berezin, Jonathan P Nakhla, Vijay Yanamadala, and Reza Yassari.
• Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. Electronic address: yaroslav.gelfand@gmail.com.
• World Neurosurg. 2021 Mar 1; 147: e78-e84.

BackgroundPatients with metastatic disease to the cervical spine have historically had poor outcomes, with an average survival of 15 months. Every effort should be made to avoid complications of surgical intervention for stabilization and decompression.MethodsWe identified patients who had undergone anterior cervical corpectomy and fusion (ACCF) or posterior cervical laminectomy and fusion (PCLF) for metastatic disease of the cervical spine using the American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2016. Patients meeting the inclusion criteria were subsequently propensity matched 1:1. We compared the overall complications, intensive care unit level complications, mortality, and return to the operating room between the 2 groups.ResultsAfter identifying the patients who met the inclusion criteria and propensity matching, a cohort of 240 patients was included, with 120 (50%) in the ACCF group and 120 (50%) in the PCLF group. The patients in the ACCF group were more likely to have experienced any complication (odds ratio, 2.1; 95% confidence interval, 1.1-4.1; P = 0.026) but not severe complications or a return to the operating room (P = 0.406 and P = 0.450, respectively).ConclusionIn the present study, we found that anterior surgical approaches (ACCF) for metastatic cervical spine disease resulted in a significantly greater rate of overall complications (2.1 times more) compared with PCLF in the first 30 days. Although more studies are required to further elucidate this relationship, the general belief that the anterior approach is better tolerated by patients might not apply to patients with metastatic tumors.Copyright © 2020 Elsevier Inc. All rights reserved.

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