LAUSR

OBJECTIVE To study a large multi-institutional sample of patients undergoing anterior vs. posterior approaches for surgical decompression of thoracic myelopathy. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for patients who underwent decompression for thoracic myelopathy between 2007 and 2015 via anterior or posterior approaches. Patients were excluded if they were undergoing surgery for tumors to isolate a degenerative cohort. Demographics, patient comorbidities, operative details and postoperative complications were compared between the two cohorts. RESULTS While there were no differences in age (p=0.06), sex (p=0.72), or ASA class (p=0.59), there were higher rates of steroid use (p=0.01) and hematologic disorders that predispose to bleeding (p=0.04) at baseline in the posterior approach cohort. The posterior approach patients had longer operative times (p=0.03), but there were no differences in length of stay (p=0.64). Although there were no significant differences in the rates of major organ system complications or return to the operating room (p=0.52), the posterior approach cohort displayed a trend towards increased severe adverse complications (29.8% vs. 17.6%, p=0.28) compared to the anterior approach cohort. CONCLUSION Although the anterior approach to surgical decompression of thoracic myelopathy demonstrated a lower complication rate, this result did not reach statistical significance. The anterior approach was associated with significantly shorter mean operative time, but otherwise there were no significant differences in operative or postoperative outcomes. These findings may support the favorability of the anterior approach but warrant further investigation in a larger study.