An Assessment of the Key Predictors of Perioperative Complications in Patients with Cervical Spondylotic Myelopathy Undergoing Surgical Treatment: Results from a Survey of 916 AOSpine International Members

BACKGROUND: Surgery for the treatment of cervical spondylotic myelopathy is typically accompanied by complication rates between 11% and 38%. By determining clinical and surgical predictors of complications, clinicians can identify high-risk patients and plan accordingly. We conducted a survey of the AOSpine community to identify key predictors of postoperative complications. METHODS: Members of AOSpine International were invited to participate. The survey was divided into 3 sections. The first and second sections focused on key clinical and imaging risk factors. The third section was designed to determine whether rates of complications differ depending on surgical approach, procedure, number of stages, and use of fusion. Results from the entire sample and from each geographic region were analyzed. RESULTS: The survey was completed by 916 participants. The presence of comorbidities was ranked as the most important clinical predictor of complications. Most respondents believed that patients with diabetes are at a higher risk of cardiac complications (69.75%) and wound infections (95.0%) than patients without diabetes. Regarding surgical technique, 40% of respondents reported higher complication rates in posterior surgery compared with anterior surgery, whereas 30% believed there is no difference. The types of complications vary significantly between approaches. However, rates of dysphagia, wound infection, dural tear, and C5 radiculopathy are similar among posterior techniques. CONCLUSIONS: This survey summarizes surgeons' perceptions of the most important clinical, imaging, and surgical risk factors for postoperative complications. Knowledge of these predictors allows clinicians to identify high-risk patients and institute prevention plans.