Urgent vs. Elective Anterior Cervical Discectomy and Fusion Outcomes in Degenerative Cervical Myelopathy

Location

LSU Health NO Center for Advanced Learning and Simulation (CALS)

Document Type

Event

Start Date

20-6-2026 10:20 AM

End Date

20-6-2026 11:20 AM

Publication Date

June 2026

Description

Introduction: Degenerative cervical myelopathy (DCM) is a progressive spinal cord disorder that is frequently underdiagnosed and can lead to permanent neurologic disability if not treated in a timely manner. Although many patients undergo elective anterior cervical discectomy and fusion (ACDF) following outpatient evaluation and triage, an increasing proportion are presenting through the emergency department and requiring urgent surgical intervention, with rates rising by approximately 3.2% per year. Prior literature has also demonstrated that unplanned surgical care is associated with a 1.34-fold increased risk of adverse events compared to elective procedures. The objective of this study is to compare discharge outcomes between elective and urgent ACDF in patients with DCM. We hypothesize that urgent procedures are associated with worse discharge disposition

Methods: This was a retrospective study that included 238 adult patients with cervical myelopathy who underwent ACDF between 2012 and 2021 at a single safety-net hospital. Surgical timing was defined as scheduled (elective) and unscheduled (urgent). Statistical analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC). Elective and urgent patients were compared using chi-square or Fisher’s exact tests for categorical variables, Student’s t-test or Wilcoxon rank-sum tests for continuous variables, and multivariable logistic regression and ANCOVA to assess the effect of surgical timing after adjustment for relevant covariates, with p<0.05 considered statistically significant.

Results: A total of 238 patients were included, with 212 in the scheduled group and 26 in the unscheduled group. Baseline demographics were similar between groups, with no significant differences in age (56.5 ± 10.3 vs 54.3 ± 11.9 years, p = 0.300), BMI (31.6 ± 7.3 vs 31.7 ± 8.8 kg/m², p = 0.940), sex (female: 98.6% vs 100%, p = 1.000), race (p = 0.138), insurance status (p = 0.578), or psychiatric comorbidities including anxiety (41.5% vs 42.3%, p = 0.938) and depression (42.0% vs 34.6%, p = 0.471). Most clinical and surgical characteristics were also comparable; however, urgent patients had significant differences in neurologic symptom distribution and higher rates of preoperative spinal cord signal change on imaging. Operative time and follow-up duration did not differ between groups (p = 0.915 and p = 0.542), with median operative times of 174 minutes (IQR 126–238) for elective cases and 176 minutes (IQR 131–223) for urgent cases, and median follow-up of 306 days (IQR 81–439.5) and 348.5 days (IQR 83–446), respectively; however, urgent patients more frequently required the use of an approach surgeon (15.4% vs 3.3%, p = 0.022). After multivariable adjustment, urgent procedures were associated with significantly longer length of stay (4.9 vs 1.6 days; p < 0.001) and markedly higher odds of non-home discharge (aOR 17.6, 95% CI 4.1–76.3; p = 0.0002) compared to elective procedures.

Discussion: Urgent ACDF was associated with significantly longer hospital stays and higher likelihood of non-home discharge despite similar operative time and follow-up. These findings suggest that disease severity at presentation and delays in care, rather than intraoperative factors, may drive worse outcomes. This is particularly relevant in safety-net settings, where barriers to timely outpatient management may contribute to increased rates of urgent intervention. Limitations include the retrospective, single-center design, but the results support improving early diagnosis and access to elective spine care.

Significance/Clinical relevance: Improving access to timely elective surgical care for DCM patients may significantly improve postoperative outcomes in safety-net populations.

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Jun 20th, 10:20 AM Jun 20th, 11:20 AM

Urgent vs. Elective Anterior Cervical Discectomy and Fusion Outcomes in Degenerative Cervical Myelopathy

LSU Health NO Center for Advanced Learning and Simulation (CALS)

Introduction: Degenerative cervical myelopathy (DCM) is a progressive spinal cord disorder that is frequently underdiagnosed and can lead to permanent neurologic disability if not treated in a timely manner. Although many patients undergo elective anterior cervical discectomy and fusion (ACDF) following outpatient evaluation and triage, an increasing proportion are presenting through the emergency department and requiring urgent surgical intervention, with rates rising by approximately 3.2% per year. Prior literature has also demonstrated that unplanned surgical care is associated with a 1.34-fold increased risk of adverse events compared to elective procedures. The objective of this study is to compare discharge outcomes between elective and urgent ACDF in patients with DCM. We hypothesize that urgent procedures are associated with worse discharge disposition

Methods: This was a retrospective study that included 238 adult patients with cervical myelopathy who underwent ACDF between 2012 and 2021 at a single safety-net hospital. Surgical timing was defined as scheduled (elective) and unscheduled (urgent). Statistical analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC). Elective and urgent patients were compared using chi-square or Fisher’s exact tests for categorical variables, Student’s t-test or Wilcoxon rank-sum tests for continuous variables, and multivariable logistic regression and ANCOVA to assess the effect of surgical timing after adjustment for relevant covariates, with p<0.05 considered statistically significant.

Results: A total of 238 patients were included, with 212 in the scheduled group and 26 in the unscheduled group. Baseline demographics were similar between groups, with no significant differences in age (56.5 ± 10.3 vs 54.3 ± 11.9 years, p = 0.300), BMI (31.6 ± 7.3 vs 31.7 ± 8.8 kg/m², p = 0.940), sex (female: 98.6% vs 100%, p = 1.000), race (p = 0.138), insurance status (p = 0.578), or psychiatric comorbidities including anxiety (41.5% vs 42.3%, p = 0.938) and depression (42.0% vs 34.6%, p = 0.471). Most clinical and surgical characteristics were also comparable; however, urgent patients had significant differences in neurologic symptom distribution and higher rates of preoperative spinal cord signal change on imaging. Operative time and follow-up duration did not differ between groups (p = 0.915 and p = 0.542), with median operative times of 174 minutes (IQR 126–238) for elective cases and 176 minutes (IQR 131–223) for urgent cases, and median follow-up of 306 days (IQR 81–439.5) and 348.5 days (IQR 83–446), respectively; however, urgent patients more frequently required the use of an approach surgeon (15.4% vs 3.3%, p = 0.022). After multivariable adjustment, urgent procedures were associated with significantly longer length of stay (4.9 vs 1.6 days; p < 0.001) and markedly higher odds of non-home discharge (aOR 17.6, 95% CI 4.1–76.3; p = 0.0002) compared to elective procedures.

Discussion: Urgent ACDF was associated with significantly longer hospital stays and higher likelihood of non-home discharge despite similar operative time and follow-up. These findings suggest that disease severity at presentation and delays in care, rather than intraoperative factors, may drive worse outcomes. This is particularly relevant in safety-net settings, where barriers to timely outpatient management may contribute to increased rates of urgent intervention. Limitations include the retrospective, single-center design, but the results support improving early diagnosis and access to elective spine care.

Significance/Clinical relevance: Improving access to timely elective surgical care for DCM patients may significantly improve postoperative outcomes in safety-net populations.